Free Florida Designation of Health Care Surrogate Form

A Designation of Health Care Surrogate names the person who makes medical decisions for you if you can't speak for yourself. It's the medical counterpart to a durable power of attorney — one covers money, the other covers care.

What it does

• Names a surrogate to make health care decisions when you're unable.
• Can allow the surrogate to act immediately, or only on incapacity — your choice.
• Can authorize access to your medical records (HIPAA).
• Pairs with a living will to cover end-of-life wishes.

How to fill it out

1. 1
   Choose your surrogate and an alternate

   Pick someone who will honor your wishes and can be reached quickly.
2. 2
   Decide when it takes effect

   Immediately, or only when a physician determines you can't decide for yourself.
3. 3
   Add HIPAA access

   Authorize your surrogate to see the medical records they'll need to decide.
4. 4
   Sign before two qualifying witnesses

   At least one witness must be unrelated and not your spouse; your surrogate can't be a witness.
5. 5
   Give copies to your surrogate and doctor

   Keep one accessible — an unfound form helps no one in an emergency.

Mistakes that void it

• Both witnesses being relatives — at least one must be neither spouse nor blood relative.
• Letting the surrogate sign as a witness (not allowed).
• Confusing it with a living will — the surrogate names who decides; the living will states what you want.
• Never giving a copy to the surrogate or physician.

Questions people ask

Rather have it done right?

A form is only as good as how it's executed. We draft and supervise signing so it holds up when it matters — flat fee, from $200. No surprises.

You're going to get through this.

Tell us what's happening. We'll tell you exactly which path applies, what it'll cost, and how long it'll take. No sales pitch. Most calls end with a 4-step plan and zero stress.