Free Florida Living Will Form
Living Will Forms, Instructions, And Services
When reviewing or using this form, remember that state laws vary and consulting an attorney is recommended before completing this process. After filling out this living will form, consider giving a copy to an attending physician and hospital.
This ensures it is entered into medical records. Moreover, giving loved ones a copy of a living will might raise concerns, but will alleviate confusion and stress if the event ever occurs. Anyone creating a Florida living will should consider designating a health care surrogate.
A health care surrogate is someone designated to make care decisions in the event that a person is at the point at which this document needs to be implemented.
The designated surrogate has the authority to meet with health care providers and determine the best course of action.
Other options not presented on this Florida living will form include:
Note: Each number correlates to a particular blank or blanks on the attached sample form.
Florida Living Will
Declaration made this ________day of_______________ , I ________________________________ willfully and voluntarily make known my desire that my dying not be artificially prolonged under the circumstances set forth below, and I do hereby declare that, if at any time I am incapacitated and
_____ I have a terminal condition.
_____ I have an end stage condition.
_____ I am in a persistent vegetative state.
and if my attending or treating physician and another consulting physician have determined that there is no reasonable medical probability of my recovery from such condition, I direct that life-prolonging procedures be withheld or withdrawn when the application of such procedures would serve only to prolong artificially the process of dying, and that I be permitted to die naturally with only the administration of medication or the performance of any medical procedure deemed necessary to provide me with comfort care or to alleviate pain.
It is my intention that this declaration be honored by my family and physician as the final expression of my legal right to refuse medical or surgical treatment and to accept the consequences for such refusal.
In the event that I have been determined to be unable to provide express and informed consent regarding the withholding, withdrawal, or continuation of life-prolonging procedures, I wish to designate, as my surrogate to carry out the provisions of this declaration:
I understand the full import of this declaration, and I am emotionally and mentally competent to make this declaration.
Additional Instructions (optional):_____________________________________________
---- End Sample Florida Living Will Form ----
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