Advanced Directive Questionnaire

Primary Power of Attorney in Fact *

A durable power of attorney (“DPOA”) is a written document by which you can designate another person as your agent for the purpose of handling your financial affairs. This person becomes known as your “attorney in fact.” It allows the attorney in fact to act on your behalf as if the attorney in fact was you. The DPOA pertains to financial and business matters.

Secondary DPOA

Primary Healthcare Surrogate *

A "Healthcare Surrogate" can be any competent adult expressly designated by you to make health care decisions on your behalf in the event of your incapacity; the surrogate's authority begins only upon your lack of capacity and subsequent inability to make decisions for yourself. The authority remains effective until you regain capacity. The surrogate can: (a) Make all health care decisions for you during your incapacity; and (b) Consult with your doctors to provide informed consent, and make only those health care decisions which he or she believes you would make for yourself under the circumstances.

Secondary Healthcare Surrogate

Primary Preneed Guardian *

Florida law allows you to name a “preneed guardian” by making a written declaration. The preneed guardian will assume the duties of guardian over you immediately in the event that you are determined to be incompetent/incapacitated by the Court. Incompetent/Incapacitated means that you no longer possess sufficient faculties to make decisions for yourself. The guardian of an incapacitated person (known as the “ward”) may exercise only those rights which were removed from the ward and delegated to the guardian by the Court.

Secondary DPOA