Appointment of Healthcare Surrogate Template

What Is the Appointment of Healthcare Surrogate?

An Appointment of Healthcare Surrogate is a legal document that designates a trusted person to make medical decisions on your behalf when you cannot make them yourself. This document grants your chosen surrogate the authority to consent to treatments, access your medical records, select healthcare providers, and make critical end-of-life decisions when you're incapacitated.

Without this designation, hospitals and doctors may be unable to share information with your family or may require court intervention to make urgent medical decisions. Family members might disagree about your care with no legal authority to resolve disputes. This document prevents those delays and conflicts by clearly establishing who speaks for you when you cannot speak for yourself.

 

 

Is This Appointment of Healthcare Surrogate Right for You?

You need this agreement if you're:

• Anyone over 18 who wants control over future medical decisions
• Someone with aging parents who needs a formal healthcare surrogate designation
• A person undergoing surgery or high-risk medical procedures
• Managing chronic illness requiring ongoing treatment decisions
• Planning ahead for potential incapacity or cognitive decline
• A parent wanting your spouse to have clear legal authority over your medical care

You definitely need this agreement if:

• You're having elective surgery without a designated healthcare decision maker
• Your family members disagree about medical treatment preferences
• You have specific end-of-life wishes requiring formal surrogate authority
• HIPAA restrictions prevent family from accessing your medical information
• You're in a relationship not legally recognized in your state

 

 

Why Thousands Trust Legal GPS Templates

Save Money. Attorney fees for estate planning documents average $300-600 per document. Get the same protection for $35.

Save Time. Download instantly and complete in under 30 minutes instead of scheduling appointments and waiting weeks for drafts.

Look Professional. Attorney-quality formatting and comprehensive provisions that hospitals and healthcare providers recognize and accept.

Keeps You Out of Court. The Authority Granted section eliminates ambiguity about your surrogate's powers, the Nomination of Guardian provision tells courts who you want if guardianship becomes necessary, and the Reliance and Indemnification clause protects healthcare providers who follow your surrogate's decisions in good faith.

 

 

 

Get Protected in 3 Simple Steps

Step 1: Secure Checkout. Complete your purchase through our encrypted payment system. Your template downloads immediately.

Step 2: Instant Download. Receive your professionally formatted template in editable format compatible with Microsoft Word and Google Docs.

Step 3: Fill In the Highlighted Fields. Complete the straightforward information fields and customization options, then execute with required witnesses or notarization based on your state's requirements.

 

Frequently Asked Questions

Can I use this template multiple times?

Yes. You can use this template as many times as needed. Update it whenever your circumstances change or your surrogate designation needs modification.

Is this contract legally binding?

Yes. When properly executed according to your state's requirements, this document creates a legally enforceable designation of healthcare surrogate. Healthcare providers and facilities are required to honor your surrogate's authority.

Do I need witnesses or notarization?

It depends on your state. Most states require two witnesses who are not your healthcare surrogate or alternate surrogates. Some states require notarization instead of or in addition to witnesses. The template includes sections for both witnesses and notarization.

What's the difference between a healthcare surrogate and a living will?

A healthcare surrogate designation names a person to make medical decisions when you cannot. A living will provides specific instructions about life-sustaining treatment in terminal conditions. They work together—the living will guides your surrogate's decisions.

Can my healthcare surrogate make decisions I wouldn't want?

Your surrogate must act in accordance with your known wishes and values. The template includes a section where you can provide specific instructions or limitations. Your surrogate's authority only applies when you cannot make decisions yourself.

When does my healthcare surrogate's authority begin?

Your surrogate's authority activates only when your attending physician determines you lack capacity to make informed healthcare decisions. Until then, you retain full authority over your own medical care.