Florida Living Will
This Living Will is created in accordance with the laws of the State of Florida. It allows individuals to express their healthcare wishes in the event they become unable to communicate their preferences.
Principal Information:
- Name: ___________________________
- Date of Birth: ____________________
- Address: __________________________
- City, State, Zip: __________________
Declaration of Wishes:
I, the undersigned, declare that if I am in a terminal condition or an end-stage condition and unable to communicate my healthcare decisions, I wish to provide the following guidelines regarding my medical treatment:
- Life-Sustaining Treatment:
- Provide me with life-sustaining treatment (Yes/No): _____________
- Artificial Nutrition and Hydration:
- Provide me with artificial nutrition and hydration (Yes/No): _____________
- Palliative Care:
- Focus on comfort rather than prolonging life (Yes/No): _____________
Appointment of Healthcare Surrogate:
If I am unable to make my own healthcare decisions, I appoint the following person as my healthcare surrogate:
- Name: ___________________________
- Relationship: ______________________
- Address: __________________________
- Phone Number: ____________________
Signatures:
I have signed this Living Will on this _____ day of ___________, 20__.
- Signature: _______________________________
- Witness 1 Name: ________________________
- Witness 1 Signature: ____________________
- Witness 2 Name: ________________________
- Witness 2 Signature: ____________________
This Living Will must be signed in the presence of two witnesses or a notary public to be valid in the state of Florida.