Forms and Templates

Forms and Templates
Homepage ➨ Attorney-Approved Do Not Resuscitate Order Document ➨ Printable Do Not Resuscitate Order Form for the State of Florida
Content Overview

Guide to Writing Florida Do Not Resuscitate Order

Filling out the Florida Do Not Resuscitate Order form is a straightforward process that requires careful consideration. Once completed, this form will communicate your wishes regarding resuscitation in a medical emergency. Follow the steps below to ensure that the form is filled out correctly.

  1. Obtain the Florida Do Not Resuscitate Order form. You can find it online or request a copy from your healthcare provider.
  2. Read the instructions provided with the form carefully to understand the requirements.
  3. Fill in your personal information, including your name, date of birth, and address.
  4. Indicate your decision regarding resuscitation by checking the appropriate box.
  5. Sign and date the form to validate your choices.
  6. Have your signature witnessed by two adults who are not related to you and who do not stand to gain from your decision.
  7. Keep a copy of the completed form for your records.
  8. Provide copies of the form to your healthcare provider, family members, and anyone involved in your care.

After completing the form, it is important to ensure that it is accessible to those who may need it. This will help guarantee that your wishes are respected in any medical situation.

PDF Form Specs

Fact Name Details
Definition The Florida Do Not Resuscitate Order (DNRO) form allows individuals to refuse resuscitation efforts in case of a medical emergency.
Governing Law This form is governed by Florida Statutes, specifically Section 401.45.
Eligibility Any adult can complete a DNRO form, including those with terminal illnesses or serious medical conditions.
Signature Requirement The form must be signed by the individual or their legal representative and a physician to be valid.

FAQ

What is a Florida Do Not Resuscitate Order (DNRO)?

A Florida Do Not Resuscitate Order (DNRO) is a legal document that allows an individual to refuse resuscitative measures in the event of cardiac or respiratory arrest. It is intended for patients who have a terminal condition or are in a state where resuscitation would not improve their quality of life.

Who can request a DNRO?

Any adult who is competent to make their own medical decisions can request a DNRO. This includes individuals who are facing serious health issues and wish to express their preferences regarding end-of-life care.

How is a DNRO created in Florida?

To create a DNRO, an individual must complete the official Florida DNRO form. This form must be signed by the patient and a physician. The physician must confirm that the patient has a terminal condition or is otherwise eligible for a DNRO.

What should I do with the DNRO once it is completed?

Once the DNRO is completed and signed, it should be kept in a place where it can be easily accessed by medical personnel. It is also advisable to provide copies to family members, caregivers, and healthcare providers to ensure that everyone is aware of the individual's wishes.

Is a DNRO valid in all medical settings?

Yes, a properly executed DNRO is valid in all medical settings, including hospitals, nursing homes, and at home. Medical staff are required to honor the order as long as it is presented in its valid form.

Can a DNRO be revoked or changed?

Yes, a DNRO can be revoked or changed at any time. The individual must communicate their decision to revoke the order and may need to complete a new form if they wish to establish a different directive.

What happens if a DNRO is not available during a medical emergency?

If a DNRO is not available during a medical emergency, medical personnel will typically proceed with resuscitation efforts. It is crucial to ensure that the DNRO is readily accessible to avoid any confusion in such situations.

Are there any costs associated with obtaining a DNRO?

There are generally no costs associated with obtaining a DNRO form itself, as it is a state-provided document. However, there may be fees for medical consultations or legal assistance if you choose to seek guidance in completing the form.

Does a DNRO affect other medical treatments?

A DNRO specifically addresses resuscitation efforts. It does not impact other medical treatments or interventions unless explicitly stated. Patients can still receive pain management, comfort care, and other necessary medical treatments.

Where can I obtain a Florida DNRO form?

The Florida DNRO form can be obtained from various sources, including healthcare providers, hospitals, and the Florida Department of Health's website. It is important to use the official form to ensure that it meets all legal requirements.

Consider Popular Do Not Resuscitate Order Forms for Specific States

Out of Hospital Dnr - Establishing a DNR order can be a sensitive conversation but is vital for ensuring that one’s healthcare wishes are respected.

The use of a Florida Promissory Note form is essential for establishing a clear and legally enforceable agreement between the parties involved in a loan transaction. By detailing critical aspects such as loan amount, interest rate, and repayment terms, this document minimizes the potential for misunderstandings. For those seeking a reliable template, the Promissory Note form serves as an excellent resource to ensure all necessary provisions are included.

How to Get Dnr - This order is recognized in many states as a means to honor patient autonomy in healthcare.

Florida Do Not Resuscitate Order Example

Florida Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is created in compliance with Florida Statutes, Chapter 401.45, regarding advance directives and patient care for individuals with a terminal condition.

Patient Information:

  • Name: ___________________________
  • Date of Birth: ____________________
  • Address: _________________________
  • City: ____________________________
  • State: ___________________________
  • Zip Code: ________________________

Healthcare Provider Information:

  • Name: ___________________________
  • License Number: _________________
  • Address: _________________________
  • Telephone Number: _______________

Statement of Purpose:

This DNR Order is made with the understanding that the patient has a terminal condition. The patient desires that cardiopulmonary resuscitation (CPR) or advanced cardiac life support (ACLS) not be performed in the event of cardiac or respiratory arrest.

This Order is valid under the following circumstances:

  1. The patient is experiencing a terminal condition.
  2. CPR or ACLS would only prolong the dying process.
  3. The patient’s wishes have been clearly communicated.

Additional Instructions:

Complete information regarding the patient's medical history and specific wishes may be attached or further clarified in a separate document.

Signature:

  • Patient or Legal Guardian Signature: ________________________
  • Date: ______________________________________

Witnesses:

  • Witness #1 Name: _______________________ Signature: ___________ Date: __________
  • Witness #2 Name: _______________________ Signature: ___________ Date: __________

This document must be retained on file and readily accessible for emergency services and healthcare providers. It is recommended that copies be distributed and shared with relevant parties.