Florida Statutory Living Will
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Florida Statutory Living Will
LIVING WILL
(Florida Statutes 765.303)
Declaration made this _____ day of ___________________________________, 20_____, 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 (initial as applicable)
_____ I have a terminal condition
or _____ I have an end-stage condition
or _____ 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medical probability of my recovery from such condition, I direct that life-prolonging procedures be withheld or withdrawn when the application of such procedures would serve only to prolong artificially the process of dying, and that I be permitted to die naturally with only the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:
Name of Surrogate: ___________________________________
Address: ___________________________________
___________________________________
Zip Code: ________________
Phone: ___________________________________
E-Mail: ___________________________________
I understand the full import of this declaration, and I am emotionally and mentally competent to make this declaration.
Additional instructions (optional):
___________________________________
___________________________________
___________________________________
Name: ___________________________________
Signed: ___________________________________
Date: __________________
WITNESSES:
Witness #1:
Signature: ___________________________________
Printed Name: ___________________________________
Address: ___________________________________
Phone: ___________________________________
E-Mail: ___________________________________
Witness #2:
Signature: ___________________________________
Printed Name: ___________________________________
Address: ___________________________________
Phone: ___________________________________
E-Mail: ___________________________________
Other Forms You May Need
- Florida General Durable Power of Attorney for Property & Finances (Upon Disability)
- Florida General Durable Power of Attorney for Property & Finances (Immediate)
- Florida Designation of Health Care Surrogate
- Florida Living Will
- Revocable Living Trust (includes Certificate of Trust Existence & Authority)
- Irrevocable Trust Agreement
Instant Download - Only $9.99
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Professional MS Word & PDF formatting
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- Lifetime updates
- Accuracy guarantee