Florida Designation of Health Care Surrogate Form


A Florida designation of health care surrogate nominates a surrogate (trusted individual) to make medical decisions for the person that completes the form (the principal). It is the official state form created by the Florida Bar and Florida Medical Association and referred to as a medical power of attorney. When writing the document, the principal can nominate another surrogate. This person is referred to as the alternate surrogate as they have decision-making power if the primary surrogate is unavailable or cannot fulfill the principal’s wishes.

The form gives those that complete it peace of mind knowing that their health care choices will be respected when (or if) they are unable to communicate them due to a medical condition. The principal must create the document before becoming incapacitated; otherwise, it is not considered valid.

Laws: §§ 765.101 – 765.547

Signing requirements (§ 765.202): The principal must sign the power of attorney in the presence of two (2) witnesses. Notarization is recommended to prove that the signing occurred.

Additional information: The form includes instructions that inform the principal on how to complete it. When writing the document, the principal must consider the following:

  1. The surrogate cannot act as one of the two (2) witnesses.
  2. The form can be revoked orally or by use of a revocation of power of attorney.
  3. Once completed, the form should be given to the principal’s physician and/or medical institution for record-keeping purposes.