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DESIGNATION OF HEALTH CARE SURROGATE FOR MINOR/We, ___, the [check one] [ ] natural guardian(s) as defined in 744.301(1), Florida Statutes; [ ] legal custodian(s); [ ] legal guardian(s) of the following
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Step 1: Obtain the designation of health care form from a healthcare provider or legal representative.
02
Step 2: Fill out your personal information including name, address, date of birth, and contact information.
03
Step 3: Specify the healthcare provider or providers who you want to make healthcare decisions for you.
04
Step 4: Sign and date the form in the presence of a witness.
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Step 5: Have the witness sign and date the form as well.
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Step 6: Keep a copy of the completed designation of health care form for your records.

Who needs designation of health care?

01
Anyone who wants to ensure that their healthcare preferences are communicated and respected in the event they are unable to make decisions for themselves.
02
Individuals who want to designate a specific person or persons to make healthcare decisions on their behalf.
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Designation of health care is a legal document that allows an individual to appoint someone to make health care decisions on their behalf if they become unable to do so.
Any adult individual may choose to file a designation of health care to ensure their medical wishes are followed in case of incapacitation.
Designation of health care can be filled out by completing a form provided by a healthcare facility or attorney, and it must be signed in the presence of witnesses.
The purpose of designation of health care is to appoint a trusted person to make medical decisions on behalf of an individual if they are unable to communicate their own wishes.
Designation of health care typically includes the name of the appointed healthcare agent, contact information, and specific instructions regarding medical treatment preferences.
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