Florida Senate - 2025                                     SB 566
       
       
        
       By Senator Rodriguez
       
       
       
       
       
       40-00699-25                                            2025566__
    1                        A bill to be entitled                      
    2         An act relating to patient-directed medical orders;
    3         amending s. 765.101, F.S.; revising and providing
    4         definitions; amending s. 765.102, F.S.; revising
    5         legislative findings and intent to include palliative
    6         care for progressive illnesses; creating s. 765.3041,
    7         F.S.; providing a purpose and requirements for a
    8         patient-directed medical order; authorizing the use of
    9         telehealth for a specified purpose; requiring that
   10         certain health care services be provided to the
   11         principal regardless of the decision to withhold or
   12         withdraw life-prolonging procedures; authorizing
   13         physicians, physician assistants, and certain advanced
   14         practice registered nurses to withhold or withdraw
   15         life-prolonging procedures under certain circumstances
   16         without penalty; providing construction; amending ss.
   17         395.1041, 400.142, 400.487, 400.605, 400.6095,
   18         400.611, 401.35, 401.45, 429.255, 429.73, 744.4431,
   19         752.001, 765.110, 765.204, 765.205, and 765.305, F.S.;
   20         conforming cross-references and provisions to changes
   21         made by the act; requiring the Agency for Health Care
   22         Administration to create and update a database for the
   23         storage of patient-directed medical orders; providing
   24         an effective date.
   25          
   26  Be It Enacted by the Legislature of the State of Florida:
   27  
   28         Section 1. Present subsections (15) through (22) of section
   29  765.101, Florida Statutes, are redesignated as subsections (16)
   30  through (23), respectively, a new subsection (15) is added to
   31  that section, and subsections (1) and (7) of that section are
   32  amended, to read:
   33         765.101 Definitions.—As used in this chapter:
   34         (1) “Advance directive” means a witnessed written document
   35  or oral statement in which instructions are given by a principal
   36  or in which the principal’s desires are expressed concerning any
   37  aspect of the principal’s health care or health information, and
   38  includes, but is not limited to, the designation of a health
   39  care surrogate, a living will, or an anatomical gift made
   40  pursuant to part V of this chapter. An advance directive may
   41  also include a patient-directed medical order.
   42         (7) “Health care facility” means a hospital, nursing home,
   43  hospice, home health agency, or health maintenance organization
   44  licensed in this state, a or any facility subject to part I of
   45  chapter 394, or an assisted living facility or adult family-care
   46  home licensed under chapter 429.
   47         (15)“Patient-directed medical order” means a medical order
   48  created by the principal in collaboration with a physician, a
   49  physician assistant, or an advanced practice registered nurse
   50  registered under s. 464.0123 which is portable across health
   51  care settings and accessible in a volunteer, online registry.
   52         Section 2. Subsection (6) of section 765.102, Florida
   53  Statutes, is amended to read:
   54         765.102 Legislative findings and intent.—
   55         (6) For purposes of this chapter:
   56         (a) Palliative care is the comprehensive management of the
   57  physical, psychological, social, spiritual, and existential
   58  needs of patients. Palliative care is especially suited to the
   59  care of persons who have incurable or, progressive illnesses.
   60         (b) Palliative care may must include:
   61         1. An opportunity to discuss and plan for end-of-life care.
   62         2. Assurance that physical and mental suffering will be
   63  carefully attended to.
   64         3. Assurance that preferences for withholding and
   65  withdrawing life-sustaining interventions will be honored.
   66         4. Assurance that the personal goals of the dying person
   67  will be addressed.
   68         5. Assurance that the dignity of the dying person will be a
   69  priority.
   70         6. Assurance that health care providers will not abandon
   71  the dying person.
   72         7. Assurance that the burden to family and others will be
   73  addressed.
   74         8. Assurance that advance directives for care, orders not
   75  to resuscitate executed pursuant to s. 401.45, and patient
   76  directed medical orders executed pursuant to s. 765.3041 will be
   77  respected regardless of the location of care.
   78         9. Assurance that organizational mechanisms are in place to
   79  evaluate the availability and quality of end-of-life,
   80  palliative, and hospice care services, including the evaluation
   81  of administrative and regulatory barriers.
   82         10. Assurance that necessary health care services will be
   83  provided and that relevant reimbursement policies are available.
   84         11. Assurance that the goals expressed in subparagraphs 1.
   85  10. will be accomplished in a culturally appropriate manner.
   86         Section 3. Section 765.3041, Florida Statutes, is created
   87  to read:
   88         765.3041Patient-directed medical orders.—
   89         (1)To facilitate a principal’s instructions concerning
   90  treatment preferences, a patient-directed medical order may be
   91  executed in advance to direct the actions of health care
   92  providers and health care facilities.
   93         (2)A valid patient-directed medical order must:
   94         (a)Be on a form adopted by rule of the Department of
   95  Health and may be combined with an order not to resuscitate
   96  executed pursuant to s. 401.45. The form must:
   97         1.Address medical interventions to be withheld or
   98  withdrawn when the application of life-prolonging procedures
   99  would serve only to prolong artificially the process of dying.
  100         2.Be signed by the principal and the principal’s
  101  physician, physician assistant, or advanced practice registered
  102  nurse registered under s. 464.0123.
  103         a.If the principal is physically unable to sign the form,
  104  the physician, physician assistant, or advanced practice
  105  registered nurse present at the discussion as required by
  106  subparagraph (b)2. may subscribe the principal’s signature in
  107  the principal’s presence and at the principal’s direction. If
  108  telehealth is used, the physician, physician assistant, or
  109  advanced practice registered nurse may be present at either
  110  location where telehealth is being administered.
  111         b.If the principal is incapacitated, the form may be
  112  signed by the principal’s health care surrogate or proxy, court
  113  appointed guardian as provided in chapter 744, or attorney in
  114  fact under a durable power of attorney as provided in chapter
  115  709. The court-appointed guardian or attorney in fact must be
  116  delegated authority to make health care decisions on behalf of
  117  the principal.
  118         c.All signatures may be electronic signatures.
  119         (b)Clearly express the principal’s preferences and
  120  instructions for care, which may include all treatments
  121  available, modified treatments that are not prolonged or
  122  burdensome, or comfort measures that do not pursue or continue
  123  interventions.
  124         1.The principal and a physician, a physician assistant, or
  125  an advanced practice registered nurse registered under s.
  126  464.0123 must discuss the principal’s medical treatment wishes
  127  relating to medical interventions to be withheld or withdrawn
  128  based on the principal’s values and preferences in the event the
  129  principal becomes unable to make her or his own decisions.
  130         2.The discussion must be in person and may be conducted
  131  using telehealth.
  132         (3)Regardless of the decision to withhold or withdraw
  133  life-prolonging procedures, necessary health care services must
  134  be provided for the care and comfort of the principal or to
  135  alleviate pain.
  136         (4)A physician, a physician assistant, or an advanced
  137  practice registered nurse registered under s. 464.0123 may
  138  withhold or withdraw cardiopulmonary resuscitation or other
  139  life-prolonging procedures if presented with an order not to
  140  resuscitate executed pursuant to s. 401.45 or a patient-directed
  141  medical order executed pursuant to this section which contains
  142  an order not to resuscitate or an order to withhold or withdraw
  143  life-prolonging procedures. A physician, a physician assistant,
  144  or an advanced practice registered nurse registered under s.
  145  464.0123 is not subject to any disciplinary action under s.
  146  456.072 or criminal prosecution or civil liability, or
  147  considered to have engaged in negligent or unprofessional
  148  conduct, for withholding or withdrawing cardiopulmonary
  149  resuscitation or other life-prolonging procedures pursuant to
  150  such orders. The absence of an order not to resuscitate executed
  151  pursuant to s. 401.45 or a patient-directed medical order
  152  executed pursuant to this section does not preclude a physician,
  153  a physician assistant, or an advanced practice registered nurse
  154  registered under s. 464.0123 from withholding or withdrawing
  155  cardiopulmonary resuscitation or other life-prolonging
  156  procedures as otherwise authorized by law.
  157         Section 4. Paragraph (l) of subsection (3) of section
  158  395.1041, Florida Statutes, is amended to read:
  159         395.1041 Access to and ensurance of emergency services;
  160  transfers; patient rights; diversion programs; reports of
  161  controlled substance overdoses.—
  162         (3) EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
  163  FACILITY OR HEALTH CARE PERSONNEL.—
  164         (l) Hospital personnel may withhold or withdraw
  165  cardiopulmonary resuscitation or other life-prolonging
  166  procedures if presented with an order not to resuscitate
  167  executed pursuant to s. 401.45 or a patient-directed medical
  168  order executed pursuant to s. 765.3041 which contains an order
  169  not to resuscitate or an order to withhold or withdraw life
  170  prolonging procedures. Facility staff and facilities are shall
  171  not be subject to criminal prosecution or civil liability, or
  172  nor be considered to have engaged in negligent or unprofessional
  173  conduct, for withholding or withdrawing cardiopulmonary
  174  resuscitation or other life-prolonging procedures pursuant to
  175  such orders an order. The absence of an order not to resuscitate
  176  executed pursuant to s. 401.45 or a patient-directed medical
  177  order executed pursuant to s. 765.3041 does not preclude a
  178  physician from withholding or withdrawing cardiopulmonary
  179  resuscitation or other life-prolonging procedures as otherwise
  180  authorized permitted by law.
  181         Section 5. Subsection (3) of section 400.142, Florida
  182  Statutes, is amended to read:
  183         400.142 Emergency medication kits; orders not to
  184  resuscitate and patient-directed medical orders.—
  185         (3) Facility staff may withhold or withdraw cardiopulmonary
  186  resuscitation or other life-prolonging procedures if presented
  187  with an order not to resuscitate executed pursuant to s. 401.45
  188  or a patient-directed medical order executed pursuant to s.
  189  765.3041 which contains an order not to resuscitate or an order
  190  to withhold or withdraw life-prolonging procedures. Facility
  191  staff and facilities are not subject to criminal prosecution or
  192  civil liability, or considered to have engaged in negligent or
  193  unprofessional conduct, for withholding or withdrawing
  194  cardiopulmonary resuscitation or other life-prolonging
  195  procedures pursuant to such orders order. The absence of an
  196  order not to resuscitate executed pursuant to s. 401.45 or a
  197  patient-directed medical order executed pursuant to s. 765.3041
  198  does not preclude a physician from withholding or withdrawing
  199  cardiopulmonary resuscitation or other life-prolonging
  200  procedures as otherwise authorized permitted by law.
  201         Section 6. Subsection (7) of section 400.487, Florida
  202  Statutes, is amended to read:
  203         400.487 Home health service agreements; physician’s,
  204  physician assistant’s, and advanced practice registered nurse’s
  205  treatment orders; patient assessment; establishment and review
  206  of plan of care; provision of services; orders not to
  207  resuscitate and patient-directed medical orders.—
  208         (7) Home health agency personnel may withhold or withdraw
  209  cardiopulmonary resuscitation or other life-prolonging
  210  procedures if presented with an order not to resuscitate
  211  executed pursuant to s. 401.45 or a patient-directed medical
  212  order executed pursuant to s. 765.3041 which contains an order
  213  not to resuscitate or an order to withhold or withdraw life
  214  prolonging procedures. The agency shall adopt rules providing
  215  for the implementation of such orders. Home health personnel and
  216  agencies are shall not be subject to criminal prosecution or
  217  civil liability, or nor be considered to have engaged in
  218  negligent or unprofessional conduct, for withholding or
  219  withdrawing cardiopulmonary resuscitation or other life
  220  prolonging procedures pursuant to such orders an order and rules
  221  adopted by the agency. The absence of an order not to
  222  resuscitate executed pursuant to s. 401.45 or a patient-directed
  223  medical order executed pursuant to s. 765.3041 does not preclude
  224  a physician from withholding or withdrawing cardiopulmonary
  225  resuscitation or other life-prolonging procedures as otherwise
  226  authorized by law.
  227         Section 7. Paragraph (e) of subsection (1) of section
  228  400.605, Florida Statutes, is amended to read:
  229         400.605 Administration; forms; fees; rules; inspections;
  230  fines.—
  231         (1) The agency shall by rule establish minimum standards
  232  and procedures for a hospice pursuant to this part. The rules
  233  must include:
  234         (e) Procedures relating to the implementation of advance
  235  advanced directives, patient-directed medical orders executed
  236  pursuant to s. 765.3041, and do-not-resuscitate orders not to
  237  resuscitate executed pursuant to s. 401.45.
  238         Section 8. Subsection (8) of section 400.6095, Florida
  239  Statutes, is amended to read:
  240         400.6095 Patient admission; assessment; plan of care;
  241  discharge; death.—
  242         (8) The hospice care team may withhold or withdraw
  243  cardiopulmonary resuscitation or other life-prolonging
  244  procedures if presented with an order not to resuscitate
  245  executed pursuant to s. 401.45 or a patient-directed medical
  246  order executed pursuant to s. 765.3041 which contains an order
  247  not to resuscitate or an order to withhold or withdraw life
  248  prolonging procedures. The agency shall adopt rules providing
  249  for the implementation of such orders. Hospice staff are shall
  250  not be subject to criminal prosecution or civil liability, or
  251  nor be considered to have engaged in negligent or unprofessional
  252  conduct, for withholding or withdrawing cardiopulmonary
  253  resuscitation or other life-prolonging procedures pursuant to
  254  such orders an order and applicable rules. The absence of an
  255  order not to resuscitate executed pursuant to s. 401.45 or a
  256  patient-directed medical order executed pursuant to s. 765.3041
  257  does not preclude a physician from withholding or withdrawing
  258  cardiopulmonary resuscitation or other life-prolonging
  259  procedures as otherwise authorized permitted by law.
  260         Section 9. Paragraph (b) of subsection (4) of section
  261  400.611, Florida Statutes, is amended to read:
  262         400.611 Interdisciplinary records of care; confidentiality;
  263  release of records.—
  264         (4) A hospice may not release a patient’s interdisciplinary
  265  record or any portion thereof, unless the person requesting the
  266  information provides to the hospice:
  267         (b) In the case of an incapacitated patient, a patient
  268  authorization executed before prior to the patient’s death by
  269  the patient’s then acting legal guardian, health care surrogate
  270  as defined in s. 765.101 s. 765.101(21), health care proxy as
  271  defined in s. 765.101 s. 765.101(19), or agent under power of
  272  attorney;
  273         Section 10. Subsection (4) of section 401.35, Florida
  274  Statutes, is amended to read:
  275         401.35 Rules.—The department shall adopt rules, including
  276  definitions of terms, necessary to carry out the purposes of
  277  this part.
  278         (4) The rules must establish circumstances and procedures
  279  under which emergency medical technicians and paramedics may
  280  honor orders not to resuscitate executed pursuant to s. 401.45
  281  or patient-directed medical orders executed pursuant to s.
  282  765.3041 which contains an order not to resuscitate or an order
  283  to withhold or withdraw life-prolonging procedures by the
  284  patient’s physician, physician assistant, or advanced practice
  285  registered nurse registered under s. 464.0123 not to resuscitate
  286  and the documentation and reporting requirements for handling
  287  such orders requests.
  288         Section 11. Paragraphs (a) and (b) of subsection (3) of
  289  section 401.45, Florida Statutes, are amended to read:
  290         401.45 Denial of emergency treatment; civil liability.—
  291         (3)(a) Resuscitation may be withheld or withdrawn from a
  292  patient by An emergency medical technician or paramedic may
  293  withhold or withdraw cardiopulmonary resuscitation or other
  294  life-prolonging procedures if presented with evidence of an
  295  order not to resuscitate executed pursuant to this subsection or
  296  a patient-directed medical order executed pursuant to s.
  297  765.3041 which contains an order not to resuscitate or an order
  298  to withhold or withdraw life-prolonging procedures by the
  299  patient’s physician or physician assistant is presented to the
  300  emergency medical technician or paramedic. An order not to
  301  resuscitate executed pursuant to this subsection or a patient
  302  directed medical order executed pursuant to s. 765.3041 which
  303  contains an order not to resuscitate or an order to withhold or
  304  withdraw life-prolonging procedures, to be valid, must be on the
  305  form adopted by rule of the department. The form must be signed
  306  by the patient’s physician, or physician assistant, or advanced
  307  practice registered nurse registered under s. 464.0123 and by
  308  the patient or, if the patient is incapacitated, the patient’s
  309  health care surrogate or proxy as provided in chapter 765,
  310  court-appointed guardian as provided in chapter 744, or attorney
  311  in fact under a durable power of attorney as provided in chapter
  312  709. The court-appointed guardian or attorney in fact must have
  313  been delegated authority to make health care decisions on behalf
  314  of the patient.
  315         (b) Any licensee, physician, medical director, or emergency
  316  medical technician or paramedic who acts under the direction of
  317  a medical director is not subject to criminal prosecution or
  318  civil liability, and has not engaged in negligent or
  319  unprofessional conduct, as a result of the withholding or
  320  withdrawal of cardiopulmonary resuscitation or other life
  321  prolonging procedures from a patient pursuant to this subsection
  322  and rules adopted by the department.
  323         Section 12. Subsection (4) of section 429.255, Florida
  324  Statutes, is amended to read:
  325         429.255 Use of personnel; emergency care.—
  326         (4) Facility staff may withhold or withdraw cardiopulmonary
  327  resuscitation, or the use of an automated external
  328  defibrillator, or other life-prolonging procedures if presented
  329  with an order not to resuscitate executed pursuant to s. 401.45
  330  or a patient-directed medical order executed pursuant to s.
  331  765.3041 which contains an order not to resuscitate or an order
  332  to withhold or withdraw life-prolonging procedures. The agency
  333  shall adopt rules providing for the implementation of such
  334  orders. Facility staff and facilities are may not be subject to
  335  criminal prosecution or civil liability, or nor be considered to
  336  have engaged in negligent or unprofessional conduct, for
  337  withholding or withdrawing cardiopulmonary resuscitation, the or
  338  use of an automated external defibrillator, or other life
  339  prolonging procedures pursuant to such orders an order and rules
  340  adopted by the agency. The absence of an order not to
  341  resuscitate executed pursuant to s. 401.45 or a patient-directed
  342  medical order executed pursuant to s. 765.3041 does not preclude
  343  a physician from withholding or withdrawing cardiopulmonary
  344  resuscitation, the or use of an automated external
  345  defibrillator, or other life-prolonging procedures as otherwise
  346  authorized permitted by law.
  347         Section 13. Subsection (3) of section 429.73, Florida
  348  Statutes, is amended to read:
  349         429.73 Rules and standards relating to adult family-care
  350  homes.—
  351         (3) The agency shall adopt rules providing for the
  352  implementation of orders not to resuscitate and patient-directed
  353  medical orders. The provider may withhold or withdraw
  354  cardiopulmonary resuscitation or other life-prolonging
  355  procedures if presented with an order not to resuscitate
  356  executed pursuant to s. 401.45 or a patient-directed medical
  357  order executed pursuant to s. 765.3041 which contains an order
  358  not to resuscitate or an order to withhold or withdraw life
  359  prolonging procedures. The provider is shall not be subject to
  360  criminal prosecution or civil liability, or nor be considered to
  361  have engaged in negligent or unprofessional conduct, for
  362  withholding or withdrawing cardiopulmonary resuscitation or
  363  other life-prolonging procedures pursuant to such orders an
  364  order and applicable rules. The absence of an order not to
  365  resuscitate executed pursuant to s. 401.45 or a patient-directed
  366  medical order executed pursuant to s. 765.3041 does not preclude
  367  a physician from withholding or withdrawing cardiopulmonary
  368  resuscitation or other life-prolonging procedures as otherwise
  369  authorized by law.
  370         Section 14. Subsections (1), (7), and (8) of section
  371  744.4431, Florida Statutes, are amended to read:
  372         744.4431 Guardianship power regarding life-prolonging
  373  procedures.—
  374         (1) Except as provided in this section, decisions by a
  375  professional guardian, as defined in s. 744.102, to withhold or
  376  withdraw life-prolonging procedures from, or to execute an order
  377  not to resuscitate pursuant to s. 401.45 or a patient-directed
  378  medical order pursuant to s. 765.3041 which contains an order
  379  not to resuscitate or an order to withhold or withdraw life
  380  prolonging procedures for, a ward must be approved by the court.
  381  A professional guardian appointed to act on behalf of a ward’s
  382  person must petition the court pursuant to the Florida Probate
  383  Rules for authority to consent to withhold or withdraw life
  384  prolonging procedures or to execute an order not to resuscitate
  385  pursuant to s. 401.45 or a patient-directed medical order
  386  pursuant to s. 765.3041. Court approval must be obtained before
  387  taking such action, except as provided in subsection (7).
  388         (7) Court approval is not required for the following
  389  decisions:
  390         (a) A decision to withhold or withdraw life-prolonging
  391  procedures made by a professional guardian to whom authority has
  392  been granted by the court under s. 744.3115 to carry out the
  393  instructions in or to take actions consistent with the ward’s
  394  advance directive, order not to resuscitate executed pursuant to
  395  s. 401.45, or patient-directed medical order executed pursuant
  396  to s. 765.3041 which contains an order not to resuscitate or an
  397  order to withhold or withdraw life-prolonging procedures, as
  398  long as there are no known objections from the ward; the ward’s
  399  attorney; the ward’s next of kin, if known; and any other
  400  interested persons as the court may direct based on s.
  401  765.105(1).
  402         (b) A decision by a professional guardian who has been
  403  delegated health care decisionmaking authority to execute an
  404  order not to resuscitate pursuant to s. 401.45 or a patient
  405  directed medical order pursuant to s. 765.3041, as described in
  406  s. 401.45(3)(a), if the ward is in a hospital and the following
  407  conditions are met:
  408         1. The ward’s primary treating physician and at least one
  409  other consulting physician document in the ward’s medical record
  410  that:
  411         a. There is no reasonable medical probability for recovery
  412  from or a cure of the ward’s underlying medical condition;
  413         b. The ward is in an end-stage condition, a terminal
  414  condition, or a persistent vegetative state as those terms are
  415  defined in s. 765.101, and that the ward’s death is imminent;
  416  and
  417         c. Resuscitation will cause the ward physical harm or
  418  additional pain.
  419         2. The professional guardian has notified the ward’s next
  420  of kin, if known, and any interested persons as the court may
  421  direct and the decision is not contrary to the ward’s expressed
  422  wishes and there are no known objections from the ward; the
  423  ward’s attorney; the ward’s next of kin, if known; or any other
  424  interested persons as the court may direct on the basis of s.
  425  765.105(1).
  426         (8) Within 2 business days after executing an order not to
  427  resuscitate pursuant to s. 401.45 or a patient-directed medical
  428  order pursuant to s. 765.3041 which contains an order not to
  429  resuscitate or an order to withhold or withdraw life-prolonging
  430  procedures under paragraph (7)(b), a professional guardian must
  431  notify the court in writing of all of the following:
  432         (a) The date the order not to resuscitate or patient
  433  directed medical order was executed.
  434         (b) The location of the ward when the order not to
  435  resuscitate or patient-directed medical order was executed.
  436         (c) The names of the physicians who documented the ward’s
  437  condition in the ward’s medical record.
  438         Section 15. Subsection (3) of section 752.001, Florida
  439  Statutes, is amended to read:
  440         752.001 Definitions.—As used in this chapter, the term:
  441         (3) “Persistent vegetative state” has the same meaning as
  442  provided in s. 765.101 s. 765.101(15).
  443         Section 16. Subsections (1) and (4) of section 765.110,
  444  Florida Statutes, are amended to read:
  445         765.110 Health care facilities and providers; discipline.—
  446         (1) A health care facility must, pursuant to Pub. L. No.
  447  101-508, ss. 4206 and 4751, shall provide to each patient
  448  written information concerning the individual’s rights
  449  concerning advance directives, orders not to resuscitate
  450  executed pursuant to s. 401.45, or patient-directed medical
  451  orders executed pursuant to s. 765.3041 which contain an order
  452  not to resuscitate or an order to withhold or withdraw life
  453  prolonging procedures and the health care facility’s policies
  454  respecting the implementation of such rights, and shall document
  455  in the patient’s medical records whether or not the individual
  456  has executed an advance directive, an order not to resuscitate
  457  pursuant to s. 401.45, or a patient-directed medical order
  458  pursuant to s. 765.3041 which contains an order not to
  459  resuscitate or an order to withhold or withdraw life-prolonging
  460  procedures.
  461         (4) The Department of Health, in consultation with the
  462  Department of Elderly Affairs, for health care providers; the
  463  Agency for Health Care Administration for hospitals, hospices,
  464  nursing homes, home health agencies, assisted living facilities,
  465  adult family-care homes, and health maintenance organizations;
  466  and the Department of Children and Families for facilities
  467  subject to part I of chapter 394 shall adopt rules to implement
  468  this section.
  469         Section 17. Subsection (3) of section 765.204, Florida
  470  Statutes, is amended to read:
  471         765.204 Capacity of principal; procedure.—
  472         (3) The surrogate’s authority commences either upon a
  473  determination under subsection (2) that the principal lacks
  474  capacity or upon a stipulation of such authority pursuant to s.
  475  765.101 s. 765.101(21). Such authority remains in effect until a
  476  determination that the principal has regained such capacity, if
  477  the authority commenced as a result of incapacity, or until the
  478  authority is revoked, if the authority commenced immediately
  479  pursuant to s. 765.101 s. 765.101(21). Upon commencement of the
  480  surrogate’s authority, a surrogate who is not the principal’s
  481  spouse shall notify the principal’s spouse or adult children of
  482  the principal’s designation of the surrogate. Except if the
  483  principal provided immediately exercisable authority to the
  484  surrogate pursuant to s. 765.101 s. 765.101(21), in the event
  485  that the primary or attending physician determines that the
  486  principal has regained capacity, the authority of the surrogate
  487  shall cease, but recommences if the principal subsequently loses
  488  capacity as determined pursuant to this section. A health care
  489  provider is not liable for relying upon health care decisions
  490  made by a surrogate while the principal lacks capacity. At any
  491  time when a principal lacks capacity, a health care decision
  492  made on the principal’s behalf by a surrogate is effective to
  493  the same extent as a decision made by the principal. If a
  494  principal possesses capacity, health care decisions of the
  495  principal take precedence over decisions made by the surrogate
  496  that present a material conflict.
  497         Section 18. Paragraph (c) of subsection (1) of section
  498  765.205, Florida Statutes, is amended to read:
  499         765.205 Responsibility of the surrogate.—
  500         (1) The surrogate, in accordance with the principal’s
  501  instructions, unless such authority has been expressly limited
  502  by the principal, shall:
  503         (c) Provide written consent using an appropriate form
  504  whenever consent is required, including the execution of an a
  505  physician’s order not to resuscitate pursuant to s. 401.45 or a
  506  patient-directed medical order pursuant to s. 765.3041 which
  507  contains an order not to resuscitate or an order to withhold or
  508  withdraw life-prolonging procedures.
  509         Section 19. Subsection (2) of section 765.305, Florida
  510  Statutes, is amended to read:
  511         765.305 Procedure in absence of a living will.—
  512         (2) Before exercising the incompetent patient’s right to
  513  forego treatment, including the execution of an order not to
  514  resuscitate pursuant to s. 401.45 or a patient-directed medical
  515  order pursuant to s. 765.3041 which contains an order not to
  516  resuscitate or an order to withhold or withdraw life-prolonging
  517  procedures, the surrogate must be satisfied that:
  518         (a) The patient does not have a reasonable medical
  519  probability of recovering capacity so that the right could be
  520  exercised by the patient.
  521         (b) The patient has an end-stage condition, the patient is
  522  in a persistent vegetative state, or the patient’s physical
  523  condition is terminal.
  524         Section 20. The Agency for Health Care Administration shall
  525  create and update a database for the storage of patient-directed
  526  medical orders, which shall be stored solely at the option of
  527  the patient in electronic form by the agency.
  528         Section 21. This act shall take effect July 1, 2025.