Step-by-Step Guide

Filling out a designation of health care surrogate form or living will can feel intimidating. Below we explain parts of our form to help you feel informed. The BayCare advance directive form is designed as a single form that has information on and the ability to complete either the designation of health care surrogate form or the living will, or both. Download  a copy of our health care surrogate and living will form.

The BayCare designation of health care surrogate and living will forms include the following main areas:

• Name declaration: In this area, to complete either the designation of health care surrogate or living will, you must fill out your legal name.

• Surrogate authority: In this area, the person filling out this form must decide when he or she wishes to have the health care surrogate begin making decisions. Initialing in either box is not required unless you want that action to occur. 

• Naming the healthcare surrogate: In this area of the form, you provide the information of your health care surrogate. This is the person that you trust to honor your health care wishes. It is recommended that an alternate be designated if possible.

• Other instructions: This area allows for additional instructions to be written into the form.

• Living will consent: This area of the form contains information related to the completion of the living will portion of the form only, and is not required if you only want to designate a healthcare surrogate. If you do not want to complete the living will portion, initialing the box is required.

• Identifying specific choices: In this section of the form, you can choose to designate some or all of the care you would like if the living will goes into effect.

• Optional information: This is where you can express any additional thoughts or concerns such as quality of life or personal beliefs. This area is not required.

• Form completion: In order for either of the designation of health care surrogate form and living form to be valid, the person the form is for must sign it.  Additionally, two witnesses must also sign the form. Your health care surrogate or surrogate alternate cannot sign the form, and at least one witness must be someone other than your spouse or blood relative.

We hope that this helps to answer any questions you may have about filling out the BayCare advance directive form. If you feel you need additional information on advance directives, here are some national organizations that can help.

• Agency for Health Care Administration
• National Health Care Decisions Day
• The American Bar Association