How to Complete and Sign the Florida Health Care Surrogate Designation Form

The Florida Health Care Surrogate Designation form names someone you trust to make medical decisions for you if you cannot speak for yourself, and it becomes legally binding once you sign it in front of two adult witnesses. No notary is required. The form follows the suggested format in Florida Statute 765.203, and any version meeting the requirements of Section 765.202 is valid.¹

Who Can Sign and Who Can Be Named

You can create the designation if you are a competent adult, or an emancipated minor. Florida presumes you are capable of making your own health care decisions unless a physician formally determines otherwise.² Competency at signing means you understand what the document does and what authority you are granting.

The person you name must be a competent adult. Florida does not require the surrogate to be a state resident or a U.S. citizen.³ Practically, though, hospital staff need to reach your surrogate fast, so someone nearby is easier to work with.

You may also name an alternate. The alternate steps in if your primary surrogate is unwilling, unable, or unavailable. Naming one is optional and skipping it does not invalidate the form.³ Adding an alternate is still worth doing, because if your only named surrogate cannot be reached in an emergency, the decision falls to a statutory priority list of relatives.

What You’ll Need to Fill In

Florida Statute 765.203 provides a suggested form, and you are not required to use that exact version.¹ Hospitals, the Florida Bar, and the Florida Department of Health all provide printable copies that track the statutory template.

Before you sit down with the form, gather:

Your full legal name
Primary surrogate: full legal name, street address, and telephone number
Alternate surrogate, if you are naming one: the same details

After the names and contact information, the form presents choices that need your initials. Take your time on this part.

The Two Immediate-Authority Boxes

By default, your surrogate’s authority does not begin until a physician determines you lack capacity. The form includes two optional boxes you can initial to grant authority sooner:¹

Immediate access to health information. If you initial this box, your surrogate can review your records and speak with your doctors right away, even while you have capacity. This is useful if you want a spouse or adult child looped in on routine care.
Immediate decision-making authority. If you initial this box, your surrogate can make health care decisions for you immediately. Your own wishes still override the surrogate’s whenever you have capacity and disagree.²

You can initial one, both, or neither. A common choice is to initial only the health-information box.

Scope and Specific Instructions

The suggested form authorizes the surrogate to make all health care decisions on your behalf, including consenting to or refusing life-prolonging procedures, applying for public or private benefits, and accessing the health information needed to do those things.⁴ There is space to write in specific limitations or instructions. If you have strong preferences about resuscitation, ventilators, feeding tubes, organ donation, or particular treatments, put them in plain language. Concrete instructions make the surrogate’s job easier when the moment comes.

Signing and Witnessing

The form becomes legally binding once you sign it in front of two adult witnesses, who must also sign in your presence.³ No notary is required. That surprises people, but two witnesses is what the statute calls for.

Two rules limit who can witness:

Neither your primary surrogate nor your alternate can serve as a witness.
At least one witness must not be your spouse or a blood relative.

A neighbor, coworker, or friend can easily fill the non-relative slot. If you are signing at a hospital or doctor’s office, staff will often witness.

If illness or injury keeps you from signing yourself, you can direct another person to sign your name for you. That person must sign in your presence and in front of both witnesses.³ Write the date of execution clearly on the form.

Remote Witnessing Is Limited

Florida allows health care advance directives to be witnessed through audio-video technology, but with real limits. Under Florida Statute 117.285, a remote online notarization provider must first screen the signer with questions about drug or alcohol influence, physical or mental conditions, and whether the signer needs daily care assistance.⁵ An affirmative answer to any of those questions ends the remote option, and the witnesses must be physically present. Vulnerable adults as defined by Florida law are also excluded from remote witnessing for these documents.

Giving Out Copies After Signing

Once the form is signed and witnessed, Florida law requires that an exact copy be provided to the surrogate.³ Beyond that minimum, give copies to:

Your alternate surrogate
Your primary care physician, so it goes in your permanent medical file
Any specialists or facilities you visit regularly
Close family members who should know the document exists and who holds authority

A photocopy carries the same legal weight as the original, so it does not matter which version anyone gets. Keep the original somewhere secure but accessible. A locked home file works. A bank safe-deposit box is a poor choice because it may be closed during a weekend emergency. Florida does not run a statewide advance-directive registry, so distribution is on you.

When the Surrogate’s Authority Kicks In

Unless you initialed the immediate-authority boxes, your surrogate’s power to make decisions activates only after a physician determines you lack capacity to make your own health care choices. If that physician is uncertain, a second physician must also evaluate you, and both findings must be entered in your medical record before the surrogate takes over.⁶ Under Florida law, “incapacity” means you are physically or mentally unable to communicate a knowing health care decision.²

While you retain capacity, your own wishes always control. Any decision you make that conflicts with your surrogate’s direction supersedes it, even when the surrogate has immediate authority.²

Changing or Revoking the Form Later

You can revoke or amend the designation at any time while you are competent. Florida Statute 765.104 gives you four ways to do it:⁷

A signed, dated writing stating you are revoking the designation
Physically destroying the document yourself, or directing someone to destroy it in your presence
An oral statement expressing your intent to revoke
Signing a new designation that is materially different from the previous one

A revocation takes effect only when it is actually communicated to the surrogate, your health care provider, or the health care facility. No one faces liability for following an old designation if they had no actual knowledge it was revoked.⁷ If you revoke orally, follow up right away by telling your doctor’s office, the hospital, and anyone holding a copy.

One automatic trigger to know about: if you named your spouse as surrogate and the marriage is later dissolved or annulled, that designation of your former spouse is automatically revoked, unless the document says otherwise or a court order provides otherwise.⁷ The designation is void as to the ex-spouse, but your doctors will not know that unless you tell them and provide a replacement form.

What Happens Without a Signed Form

If you become incapacitated without a signed designation, Florida Statute 765.401 establishes a priority list of people who can make health care decisions for you:⁸

A court-appointed guardian, if one already exists
Your spouse
A majority of your adult children who are reasonably available
A parent
A majority of your adult siblings who are reasonably available
An adult relative who has shown special care and maintained regular contact with you
A close friend
A licensed clinical social worker selected by the facility’s bioethics committee

The list works in order. If no one in a higher category is available, willing, and competent, the next category steps in. When multiple adult children or siblings share a tier, agreeing on a “majority” decision under time pressure is often where families stall. Signing a one-page form while you are healthy removes that risk.

1
The Florida Legislature. Florida Code 765.203 – Suggested Form of Designation
2
The Florida Legislature. Florida Statutes – Health Care Advance Directives
3
The Florida Legislature. Florida Code 765.202 – Designation of a Health Care Surrogate
4
Florida Senate. Florida Code 765.203 – Suggested Form of Designation
5
The Florida Legislature. Florida Code 117.285
6
The Florida Legislature. Florida Code 765.204 – Capacity of Principal; Determination
7
Florida Senate. Florida Code 765.104 – Amendment or Revocation
8
The Florida Legislature. Florida Code 765.401 – The Proxy