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.