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DESIGNATION OF HEALTH CARE SURROGATEI, ___, designate as my health care surrogate under 765.202, Florida Statutes: Name: Address: Phone:___ ___ ___If my health care surrogate is not willing, able,

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How to fill out designation of health care

01

Obtain the designation of health care form from your healthcare provider or online.

02

Fill in your personal information such as name, address, date of birth, and contact information.

03

Specify the individuals you wish to designate as your healthcare decision maker(s).

04

Indicate any specific instructions or preferences for your healthcare treatment.

05

Sign and date the form in the presence of witnesses or a notary public.

06

Make copies of the completed form and provide them to your healthcare provider and designated decision maker(s).

Who needs designation of health care?

01

Anyone over the age of 18 who wants to ensure their healthcare wishes are followed in the event they become unable to make decisions for themselves.

02

Individuals with chronic illnesses, terminal conditions, or advanced age may find designation of health care particularly useful.

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What is designation of health care?

Designation of health care refers to a legal document that allows an individual to designate another person to make healthcare decisions on their behalf if they become unable to do so themselves.

Who is required to file designation of health care?

Any individual who wishes to have someone make healthcare decisions for them in case of incapacitation is encouraged to file a designation of health care.

How to fill out designation of health care?

To fill out a designation of health care, an individual must complete a form that typically includes personal information, the names of the designated healthcare proxy, and signatures from witnesses or a notary.

What is the purpose of designation of health care?

The purpose of designation of health care is to ensure that a person's healthcare preferences are respected and that a trusted individual can make decisions on their behalf when needed.

What information must be reported on designation of health care?

The information that must be reported typically includes the name and contact information of the individual designating the proxy, the name of the designated healthcare proxy, any specific healthcare wishes, and signatures.

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