Florida Medical Power of Attorney
This Florida Medical Power of Attorney is a legal document that grants an individual (referred to as the "Agent") the authority to make health care decisions on behalf of another person (the "Principal"), in the event that the Principal is unable to make decisions for themselves. This document is designed to be in compliance with the Florida Health Care Advance Directive Act.
Please provide the following information to complete this document:
- Full Name of the Principal:
- Principal's Date of Birth:
- Principal's Address:
- Full Name of the Agent:
- Agent's Address:
- Alternative Agent (if any), in the event the first Agent is unable or unwilling to serve:
- Detailed List of Specific Powers Granted to the Agent:
- Limitations (if any) on the Agent's Authority:
- Principal's Signature and Date:
- Agent's Signature and Date:
- Alternative Agent's Signature and Date (if applicable):
- Witnesses' Signatures and Dates:
IMPORTANT: The Principal and the Agent should keep copies of this document. The Agent should be prepared to present this document to healthcare providers to carry out the Principal’s wishes regarding medical treatment.
Note: This document does not authorize the Agent to make any financial transactions on behalf of the Principal.
Once completed, this Florida Medical Power of Attorney must be signed by the Principal, the Agent, the alternative Agent (if applicable), and must be witnessed by two individuals who are not related to the Principal by blood or marriage and who are not designated as the Agent or the alternative Agent. These witnesses must attest that the Principal appeared to understand the nature and significance of the document and was free from duress or undue influence at the time of signing.