How to Complete the Florida Medical Power of Attorney: Health Care Surrogate

A Florida health care surrogate designation is a short written document in which you name an adult to make medical decisions for you if you can’t make them yourself. The form is free, needs no attorney, and becomes legally effective the moment you sign it in front of two qualified witnesses. Florida Statutes Chapter 765 sets every rule that governs it, from who can sign to what powers the surrogate holds.

Who Can Sign and Who You Can Name

You, the “principal,” must be a competent adult when you sign.¹ Competence here means you understand what the document does and can communicate a knowing decision at the moment you sign. Being hospitalized for mental illness or having an intellectual disability does not, on its own, mean you lack capacity to execute the form.²

The person you choose as surrogate must also be a competent adult.³ Pick someone who will actually answer the phone during a crisis, who can hold their ground with doctors, and who you trust to follow your wishes rather than their own.

Where to Get the Form

The suggested statutory form appears in Florida Statutes § 765.203. The legislature is explicit that this exact form is optional; any written document that meets Chapter 765’s requirements is valid.⁴ The Florida Agency for Health Care Administration publishes downloadable advance directive forms approved by the Florida Supreme Court, and The Florida Bar’s consumer resources page links to the same materials.⁵ There is no filing fee. An attorney is reasonable if your family situation is complex or you want this coordinated with a durable power of attorney for finances, but it is not required.

Decisions to Make Before You Fill Anything Out

Four things need to be settled in your own head before the pen hits the page.

Primary surrogate. Full legal name, current home address, and a phone number that will be answered. Nicknames and old addresses cause real problems at 2 a.m. in an ER.

Alternate surrogate. The same information for a backup. If your primary is unreachable or declines to act, the alternate steps in automatically. Leaving this blank is one of the most common mistakes people make, and the one most likely to matter.

When the surrogate’s authority begins. By default, your surrogate has no power to act until a physician determines you lack capacity to make your own decisions. You can instead choose to make the authority effective immediately, either for receiving your health information, for making health care decisions, or both. The statutory form has separate checkboxes for each option.²⁶ Immediate authority is useful if, for example, you want your surrogate to speak with doctors on your behalf during a long recovery when you are conscious but exhausted.

Scope, limits, and end-of-life wishes. You can grant full authority over every health care decision or narrow it. Common limits include prohibiting specific procedures, restricting authority to one illness or hospitalization, or requiring consultation with named family members. The form also lets you address life-prolonging treatments directly: resuscitation, mechanical ventilation, artificial nutrition and hydration. Writing out these preferences gives your surrogate both guidance and legal cover.

Filling Out the Form

Print it or use a fillable version. Write your full legal name as the principal. Enter the primary surrogate’s name, address, and phone in the designated fields, then do the same for the alternate. If you want immediate authority for health information access, decision-making, or both, initial the matching boxes. Leaving them blank keeps the default rule: authority begins only after a physician finds you incapacitated.

The body of the form has space for specific instructions and limitations. If you want your surrogate to have broad authority with no restrictions, say so plainly. If you want limits, write them in plain language right there. Vague instructions create problems. “Do what you think is best” gives your surrogate no real guidance and can lead to family disputes. Concrete directions carry much further: for example, “I do not want to be kept on a ventilator for more than 14 days if two physicians agree there is no reasonable chance of recovery.”

The form includes an optional HIPAA authorization. Granting it means your health care providers must treat your surrogate as your personal representative and share clinical information with them the same way they would with you. Skip this box and hospitals may refuse to discuss your condition with the person you picked, which defeats most of the point.

Signing and Witness Rules

Florida law requires you to sign the form in the presence of two adult witnesses, who must also sign.⁷ Two witness rules trip people up:

If a physical limitation keeps you from signing, you may direct another person to sign your name for you, in the witnesses’ presence.⁷ That person should not be the surrogate or either witness.

Notarization is not required under Florida law. Adding a notary acknowledgment is common practice anyway and tends to reduce pushback from out-of-state facilities or institutions unfamiliar with Florida’s rules. A Florida notary can charge no more than $10 per notarial act.⁸

After You Sign: Who Gets a Copy

Florida law requires that an exact copy of the signed document be provided to the surrogate.⁷ Beyond that minimum, send copies to:

Your alternate surrogate, so they are ready if the primary cannot act.
Your primary care physician, with a request that the office scan it into your electronic health record.
Any hospital or surgical center where you have a procedure scheduled.
Close family members. They do not get legal authority from this, but knowing the designation exists reduces conflict during emergencies.

Keep the original somewhere both safe and reachable. A locked safe deposit box no one else can open during a weekend emergency is worse than a clearly labeled folder at home. Your surrogate should know exactly where the original lives and should carry a copy, physical or digital, in case a facility asks for proof of authority at admission.

What Your Surrogate Can Do Once Active

Once authority is triggered, your surrogate has broad powers. They can consent to or refuse any health care treatment, provide written consent for procedures including a physician’s do-not-resuscitate order, authorize your admission to or discharge from a health care facility, and access your health information. They can also apply for public benefits like Medicare and Medicaid on your behalf and reach into your financial records to the extent needed to complete those applications.⁹

Your surrogate is legally required to make the decisions they believe you would have made in the same situation. If there is no indication of what you would have chosen, the surrogate may fall back on your best interest.⁹ This is why specific written instructions matter: they protect the surrogate from second-guessing and family disagreement. Health care providers who follow a surrogate’s instructions in good faith are immune from criminal prosecution and civil liability.¹⁰

How Incapacity Gets Triggered

Unless you selected immediate authority, your surrogate cannot act until a physician formally determines you cannot make your own health care decisions. Your attending or primary physician performs the evaluation and records the finding in your medical record. If that physician has any doubt, a second physician must also evaluate you, and both evaluations go into the record.² The facility then notifies your surrogate in writing that their authority has begun.

If you later regain capacity, the surrogate’s authority pauses. It resumes automatically if you lose capacity again. No new form is needed each time.² While you have capacity, your own wishes control, and doctors must communicate treatment plans and changes to you directly.

Changing or Revoking the Designation

You can revoke or amend your designation at any time, as long as you are competent, using any of these methods:

A signed, dated written statement saying you revoke it.
Physically destroying the document (tearing it up, shredding it) yourself or by directing someone to do it in your presence.
An oral statement that you intend to revoke. This works, but proving it later is harder.
Signing a new designation that is materially different from the old one. The new document effectively replaces the old.¹¹

The revocation takes effect only when it is communicated to the surrogate, your health care provider, or the facility. Until that communication happens, no one faces liability for acting on the old document in good faith.¹¹ If you revoke by destroying the original, chase down and destroy the copies you handed out too. An old copy sitting in a hospital’s electronic health record can cause serious confusion.

One automatic revocation worth knowing: if you divorce and your spouse was named as surrogate, the divorce itself revokes that designation unless the document says otherwise.¹¹ If you want your ex-spouse to keep serving as surrogate after the divorce, execute a new designation.

If You Spend Time in Another State

Whether another state will honor your Florida designation depends on that state’s reciprocity laws. Many states accept out-of-state advance directives that were properly executed under the originating state’s rules, but not all do. If you split time between Florida and another state, the safest approach is to execute a separate designation under each state’s law. At a minimum, carry a copy of your Florida form when you travel, and consider adding the optional notary block to reduce friction with facilities unfamiliar with Florida’s requirements.¹²

1
The Florida Legislature. Florida Code 765.101 – Definitions
2
The Florida Legislature. Florida Code 765.204 – Capacity of Principal; Procedure
3
UF Health. Health Care Surrogate
4
The Florida Legislature. Florida Code 765.203 – Suggested Form of Designation
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The Florida Bar. Living Wills, Health Care Surrogates, and Advanced Directives
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Florida Health Care Plans. Designation of Health Care Surrogate
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The Florida Legislature. Florida Code 765.202 – Designation of a Health Care Surrogate
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The Florida Legislature. Florida Code 117.05 – Use of Notary Commission
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The Florida Legislature. Florida Code 765.205 – Responsibility of the Surrogate
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Florida Senate. Florida Code 765.109 – Immunity From Liability; Weight of Proof; Presumption
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The Florida Legislature. Florida Code 765.104 – Amendment or Revocation
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Florida Agency for Health Care Administration. Consumer Guides – Health Care Advance Directive