What is a health care surrogate?
Who speaks for your loved one with doctors when dementia makes it hard for them to speak for themselves.
A health care surrogate is the person a Floridian names in writing, under Chapter 765 of the Florida Statutes, to make medical decisions if they cannot. The designation must be signed in front of two adult witnesses. Without one, Florida law sets a priority list of relatives who act as proxy.
What it looks like day to day
Your loved one is admitted to the ER with pneumonia and is too confused to answer questions.
With a surrogate designation on file, the named person can talk with doctors, consent to or refuse treatment, review records and decide on a move to rehab or hospice, guided by your loved one’s known wishes. Without one, the hospital turns to Florida’s default list, which can lead to delays or family disagreements.
Florida rules (Chapter 765)
- In writing, two witnesses: Florida Statutes s. 765.202 requires a written designation signed by the principal in the presence of two subscribing adult witnesses. If the principal cannot sign, another person may sign the principal’s name at their direction in the witnesses’ presence.
- Witness limits: The surrogate cannot be a witness, and at least one witness must be neither the spouse nor a blood relative.
The form also has a few practical details:
- Copy to the surrogate: The surrogate must receive an exact copy.
- Alternate: You may name an alternate who steps in if the first choice is unwilling, unable or unavailable.
- Immediate authority option: The document can let the surrogate act right away, without a formal finding of incapacity; this can help with dementia, where capacity fluctuates.
If there is no surrogate
Under s. 765.401, a proxy is chosen in order: a court-appointed guardian authorized for medical decisions, then the spouse, then a majority of adult children, then a parent, a majority of adult siblings, a close adult relative, a close friend, and finally a clinical social worker or court-approved guardianship graduate chosen by the provider’s bioethics committee.
Surrogate, proxy or guardian: what is the difference?
| Role | Who chooses | When it applies |
|---|---|---|
| Health care surrogate | Your loved one, in writing | When they cannot decide, or right away if the form says so |
| Proxy | Florida law’s priority list | Only when no surrogate or guardian is available |
| Guardian | A court | After a court process, often when no documents exist |
A health care surrogate keeps the choice with your loved one. Under s. 765.202, the designation stays in effect until your loved one revokes it, unless the document sets an end date.
What helps
- Sign while your loved one can understand the choice, ideally soon after diagnosis.
- Have the conversation about values: hospital stays, feeding tubes, comfort-first care.
- Keep copies with the surrogate, the doctor, and in the “go bag” with the hospital information sheet.
- Consider a living will too, and talk with a Florida elder law attorney. This page is general information, not legal advice.
Our Florida legal and financial planning guide explains how the documents fit together.
Choosing the right health care surrogate
- Someone who will follow your loved one’s wishes, even when they would choose differently
- Calm under pressure in an ER or ICU
- Reachable by phone, ideally living in Florida or able to travel quickly
- Willing to talk openly with doctors and with the rest of the family
- Backed by a named alternate
Then have the conversation.
Useful questions: Would you want to go to the hospital for a serious infection late in the illness? How do you feel about a feeding tube? What matters most at the end: comfort, being at home, having family near? Write the answers down and give a copy to the health care surrogate. The Alzheimer’s Association Helpline (800-272-3900) can point you to legal and financial planning resources.
When to involve the doctor
Give a copy to the primary care doctor and any specialists so it is in the chart. If capacity is uncertain at signing, ask the doctor to note your loved one’s ability to make the decision.
Health care surrogate vs. durable power of attorney
The surrogate covers medical decisions. A durable power of attorney covers finances and property. They are separate Florida documents with different signing rules; most families need both.
Keeping the surrogate informed
A surrogate who lives far away needs good information. Our companions leave a brief note after every visit, which helps long-distance families stay current. See dementia companion care and our Florida cost guide.
Related terms
Stay informed between visits
Visit notes after every companion visit keep the whole family, and the surrogate, up to date. $35/hour for 40+ hours a week.
Frequently asked questions
Still have questions?
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- Florida ADRD training before the first visit
How many witnesses does a Florida health care surrogate need?
Two adult witnesses. The surrogate cannot be one of them, and at least one must not be the spouse or a blood relative (s. 765.202).
Who makes medical decisions in Florida if there is no surrogate?
Florida’s proxy list in s. 765.401 applies: a guardian, then the spouse, then a majority of adult children, then parents, siblings, other relatives and close friends.
Does a health care surrogate need to be notarized in Florida?
Section 765.202 requires a signed writing with two adult witnesses; it does not list notarization as a requirement. Ask an attorney about your situation.
Is a health care surrogate the same as a power of attorney?
No. The surrogate handles medical decisions; a durable power of attorney handles finances.
What is the difference between a health care surrogate, a proxy and a guardian?
A health care surrogate is chosen by your loved one in writing and acts when they cannot decide, or right away if the form says so. A proxy comes from Florida law’s priority list and applies only when no surrogate or guardian is available. A guardian is appointed by a court after a court process, often when no documents exist. A surrogate keeps the choice with your loved one; our Florida legal and financial planning guide explains how the documents fit together.
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