Health Care Surrogate Designation

A Health Care Surrogate Designation is another type of advance directive. It is a legal document signed and dated by you, and executed in the presence of two witnesses. This document designates another person (and alternate person[s]) as your representative to make medical decision for you if you are unable to make the decisions yourself. You can include instructions about any treatment you want (or do not want), similar to a Living Will. Unless the document states a time of termination, the Designation shall remain in effect until revoked by you.

Just like a Living Will, a Health Care Surrogate Designation can be changed or canceled at any time. Any changes should be signed and dated by you, and executed in the presence of two witnesses.

The authority of the person you appoint as your surrogate shall commence upon a determination (by attending physician[s]) that you lack capacity. This authority shall remain in effect until a determination is made that you have regained such capacity. When determined incapacitated, your surrogate shall have authority to make all health care decisions for you; quickly consult with appropriate health care providers; provide written consent (using appropriate form) whenever consent is required, including a physician’s order not to resuscitate; be provided access to your medical records; and apply for public benefits, including Medicare and Medicaid.