Health Care Surrogate
Who is a health care surrogate and when does the designation take effect?
Your health care surrogate is a person you authorize via a Designation of Health Care Surrogate form to make medical decisions for you when you are unable to make your own decisions. It is important that you discuss your wishes in advance with your health care surrogate. If your health care surrogate does not know the decisions you would have made, he or she should make decisions based on what is in your best interest.
Who can be a health care surrogate?
Any competent adult who is at least 18 years old can be your health care surrogate. Ask that person whether he or she agrees to act for you before you complete your advance directive. You may also want to choose a second person as an alternate in case your first choice is unavailable or otherwise unable to make decisions on your behalf. If you appoint your spouse as your health care surrogate and you later divorce, the appointment of your spouse is revoked unless you say otherwise in your advance directive.
Does my Designation of Health Care Surrogate form have to be signed and witnessed?
Yes, you must sign and date the form or have someone else sign for you in your presence and at your direction if you are unable to sign. It must also be witnessed by two adults. Neither witness can be your designated surrogate, and at least one witness cannot be your spouse or a blood relative.
Questions? Please contact us at firstname.lastname@example.org
Advance Directive Forms
- Your Starter Kit: Planning Your Advance Directives
- Health Care Surrogate Form (PDF)
- Anatomical Donation (PDF)
- Do Not Resuscitate (DNR) Order (PDF)
Important! In order to be legally valid this form MUST be printed on yellow paper: EMS and medical personnel are only required to honor the form if it is printed on yellow paper.
- Living Will (PDF)
- Paquete de Directivas Anticipadas (Español)
- How to add your Advance Directive to your medical record (PDF)