Florida Living Will
This Living Will is created in accordance with Florida Statutes, Chapter 765, relating to Health Care Advance Directives.
I, [Your Full Name], residing at [Your Address], and born on [Your Date of Birth], declare this to be my Living Will.
This document expresses my wishes regarding medical treatment in the event that I become unable to communicate my preferences. I understand that in the future I may be unable to make my own healthcare decisions due to a terminal condition, end-stage condition, or persistent vegetative state.
In the event that I am faced with any of the above conditions, I wish for the following:
- Do not resuscitate efforts if my heart stops or I stop breathing.
- To receive only comfort care, not life-sustaining treatment.
- To be allowed to die naturally and comfortably.
If I am unable to communicate my wishes, I designate the following individual as my healthcare surrogate:
Name: [Surrogate's Full Name]
Address: [Surrogate's Address]
Phone Number: [Surrogate's Phone Number]
In the absence of my designated surrogate, I trust the following individuals to make healthcare decisions on my behalf:
- Name: [Alternate Surrogate 1's Full Name]
- Name: [Alternate Surrogate 2's Full Name]
This Living Will revokes any prior Living Wills made by me.
Signed this _____ day of ______________, 20____.
______________________________
Signature
______________________________
Printed Name
Witnesses:
I hereby declare that the person signing above is known to me, and that they signed this Living Will in my presence.
- ______________________________
Witness 1 Signature
- ______________________________
Witness 1 Printed Name
- ______________________________
Witness 2 Signature
- ______________________________
Witness 2 Printed Name