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Florida Living Will Form (Advance Directive) |
The Florida living will is
How to Write
Living Will
Principal`s details.
- Date.
- Principal`s name.
Conditon
Initial to designate conditions where dying is not to be prolonged.
- Terminal condition.
- End stage condition.
- Persistent vegetative state.
Agent
Enter details of agent.
- Name.
- Address.
- ZIP code.
- Telephone number.
Additional Istructions
Explain the preferences of the principal regarding medical treatment and support.
- Enter details and instructions for any specific medical requirements.
- Principal`s signature.
Witnesses
Enter details of witnesses.
- Name.
- Address.
- ZIP code.
- Telephone number.
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Designated Health Care Surrogate
Enter the details required to designate an agent or alternative agents for power of attorney.
- Principal`s name.
- Principal`s age.
- Name of agent`s.
- Relationship of agent`s.
- Address of agent`s.
- Home & work telephone number of agent`s.
Additional Instructions (Optional)
Enter details of any other relevant health care directions which the principal would require.
- Specific explanation of healthcare required by principal
Witnesses
Enter witnesses details.
- Witness #1`s name.
- Witness #1`s signature.
- Witness #2`s name.
- Date.
Living Will
Enter details regarding withholding treatment for the prolonging of life.
- Initial to withhold treatment.
- Initial and enter specific details of any conditions regarding treatment to prolong life.
Enter details regarding administration/withholding of nutrition.
- Initial to agree to administration of nutrition.
- Initial to agree to withhold nutrition.
Enter details of any other directions regarding administration of nutrition.
- Enter specific details regarding nutritional requirements.
Witnesses
Enter details of witnesses.
- Witness #1`s name.
- Witness #1`s signature.
- Witness #2`s name.
- Date.
