Florida Living Will Template
This Living Will is created pursuant to the laws of the State of Florida. It provides guidance on medical care preferences in the event that the individual is unable to communicate their wishes due to illness or incapacitation.
Individual Information:
- Name: ___________________________
- Date of Birth: _____________________
- Address: __________________________
- Phone Number: _____________________
Declaration:
I, the undersigned, being of sound mind and at least 18 years of age, hereby declare that if I am diagnosed with a terminal condition, or if I am in a persistent vegetative state, or if I have an advanced stage of an irreversible condition, I direct that my life be prolonged only if it is in accordance with my wishes as expressed in this document.
Preferences Regarding Medical Treatment:
- In the event that I am unable to communicate my desires, I wish to make the following preferences clear:
- Life-sustaining treatments should be withheld or withdrawn if:
- I have a terminal condition.
- I am in a persistent vegetative state.
- My attending physician determines that I am in an irreversible state of decline.
- I prefer comfort care measures, such as:
- Pain management.
- Emotional and spiritual support.
Appointment of Health Care Surrogate:
I designate the following person to make health care decisions on my behalf if I am unable to do so:
- Name: ___________________________
- Relationship: ______________________
- Address: __________________________
- Phone Number: _____________________
This Living Will reflects my wishes and constitutes my final expression of intent regarding medical treatment. I understand that I can revoke this document at any time when I am competent to do so.
Signature: _________________________
Date: ____________________________