What Form Does a Doctor Use to State Incapacity of A Person?
- Category:Power of Attorney
- Advanced Health Care Directive
- State: FL #18307
My mother has Alzhiemers and was unable to have contaract surgery due to her inability to remember what she was to have done. She does have a durable POA w/ healthcare provisions prepared by a lawyer and signed by my mother. In that document it requires a her primary physician to write an affidavit that she has been personally been examined and that she is unable to manage her property. Is there a specific form that the Dr needs to fill out or is an letter stating the above sufficient? And does that document need to be notorized?
An affidavit needs to be signed in front of a notary. Please see the form below and the following Florida statute:
765.204 Capacity of principal; procedure. —
(1) A principal is presumed to be capable of making
health care decisions for herself or himself unless she or
he is determined to be incapacitated. Incapacity may not be
inferred from the person's voluntary or involuntary
hospitalization for mental illness or from her or his mental
(2) If a principal's capacity to make health care decisions
for herself or himself or provide informed consent is in
question, the attending physician shall evaluate the
principal's capacity and, if the physician concludes that
the principal lacks capacity, enter that evaluation in the
principal's medical record. If the attending physician has a
question as to whether the principal lacks capacity, another
physician shall also evaluate the principal's capacity, and
if the second physician agrees that the principal lacks the
capacity to make health care decisions or provide informed
consent, the health care facility shall enter both
physician's evaluations in the principal's medical record.
If the principal has designated a health care surrogate or
has delegated authority to make health care decisions to an
attorney in fact under a durable power of attorney, the
facility shall notify such surrogate or attorney in fact in
writing that her or his authority under the instrument has
commenced, as provided in chapter 709 or s. 765.203.
(3) The surrogate's authority shall commence upon a
determination under subsection (2) that the principal lacks
capacity, and such authority shall remain in effect until a
determination that the principal has regained such capacity.
Upon commencement of the surrogate's authority, a surrogate
who is not the principal's spouse shall notify the
principal's spouse or adult children of the principal's
designation of the surrogate. In the event the attending
physician determines that the principal has regained
capacity, the authority of the surrogate shall cease, but
shall recommence if the principal subsequently loses
capacity as determined pursuant to this section.
(4) A determination made pursuant to this section that a
principal lacks capacity to make health care decisions shall
not be construed as a finding that a principal lacks
capacity for any other purpose.
(5) In the event the surrogate is required to consent to
withholding or withdrawing life-prolonging procedures, the
provisions of part III shall apply.
Please see the information at the following links:
Please see the forms at the following links:
08/28/2009 - Category: Advanced Health Care Directive - State: FL #18307
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