Provide informed consent, refusal of consent, or withdrawal of consent to any and all of my health care, including life-prolonging procedures. Apply on my behalf for private, public, government, …
Provide informed consent, refusal of consent, or withdrawal of consent to any and all of my health care, including life-prolonging procedures. Apply on my behalf for private, public, government, …
Am I required to have an advance directive under Florida law? It is a written or oral statement about how you want medical decisions made should you not be able to make them yourself …
I fully understand that this designation will permit my designee to make health care decisions and to provide, withhold, or withdraw consent on my behalf; to apply for public benefits to defray …
AUTHORITY TO MAKE HEALTH CARE DECISIONS FOR ME TAKES EFFECT IMMEDIATELY. PURSUANT TO SECTION 765.204(3), FLORIDA STATES, ANY INSTRUCTIONS OF …
Provide informed consent, refusal of consent, or withdrawal of consent to any and all of my health care, including life-prolonging procedures. Apply on my behalf for private, public, government, …
Designation of a Health Care Surrogate This health care surrogate designation form will help the healthcare team speak to the person you trust to speak on your behalf when you are no longer …
advance directive or designated a health care surrogate, health care decisions may be made for you by a court appointed guardian, your spouse, your adult child, your parent, your adult …
I fully understand that this designation will permit my designee to make health care decisions and to provide, withhold, or withdraw consent on my behalf; to apply for public benefits to defray …
telephone (_____) _____as m y h e a l t h ca r e a gee n t with authority to make health care decisions on my behalf. (Optional: If this person is unavailable, unwillin g, or incompetent to …