Valid  Do Not Resuscitate Order Template for Florida

Valid Do Not Resuscitate Order Template for Florida

The Florida Do Not Resuscitate Order form is a legal document that instructs healthcare professionals not to perform cardiopulmonary resuscitation (CPR) in the event the patient's breathing or heart stops. This form is used by individuals who, for personal, medical, or ethical reasons, choose not to undergo potentially life-saving measures under certain circumstances. For those interested in this option, detailed guidance on how to fill out the form can be found by clicking the button below.

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In the state of Florida, individuals have the option to make advanced decisions about their healthcare, particularly concerning the measures that should be taken in the event that they are unable to make such decisions for themselves. One crucial document in this realm is the Do Not Resuscitate Order (DNRO) form, an official declaration used to communicate a patient's wish not to receive cardiopulmonary resuscitation (CPR) if their heart stops beating or if they stop breathing. This document holds significant weight, as it directly influences the emergency medical services and healthcare providers' actions, ensuring that the individual's preferences regarding life-sustaining treatment are respected. The form requires specific criteria to be valid, including the signature of the individual (or their legally authorized representative) and a physician, signifying the mutual agreement on the decision. Its implementation and recognition across various scenarios illustrate the delicate balance between respecting patient autonomy and providing medical care, making it a critical aspect of healthcare planning and emergency medical consideration in Florida.

Preview - Florida Do Not Resuscitate Order Form

Florida Do Not Resuscitate Order (DNR)

This document is a legal Do Not Resuscitate Order for the State of Florida, following the guidelines outlined in the Florida Statutes Chapter 401, Section 45. It serves as a directive for health care providers not to perform cardiopulmonary resuscitation (CPR) in the event the individual's heart stops beating or they stop breathing.

Please fill in all the required information accurately to ensure this document reflects your wishes.









Statement of Declaration

By signing this document, I, _____[Patient's Full Name]_____, declare that I am fully aware and understand the nature and purpose of this document. I am aware that this document directs medical personnel not to perform lifesaving CPR on me in case my breathing or heartbeat stops. This decision is made voluntarily and without any influence from external parties.







The witness confirms that the patient signed this document willingly and was not under duress or undue influence.





The signing physician confirms that the patient fully understands the nature of the Do Not Resuscitate Order and its implications.

Important Notes:

  • This document must be reviewed regularly, and a new one must be issued if any information changes or at the discretion of the patient or their legal representative.
  • A Do Not Resuscitate Order does not affect the provision of other medical treatments or interventions that may be beneficial to the patient's health condition, other than the initiation of CPR.
  • This document must be presented to the healthcare provider or emergency personnel to be legally valid.

For more information about Do Not Resuscitate Orders in Florida, please consult your healthcare provider or visit the official website of the Florida Department of Health.

Document Information

Fact Number Fact Detail
1 The Florida Do Not Resuscitate Order (DNRO) form is used to instruct healthcare providers not to administer cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient's heart stops beating.
2 It is governed by Florida Statute 401.45, which provides the legal framework within which DNROs operate in the state.
3 The form must be signed by the patient, or if the patient is incapacitated, their legal representative or proxy may sign on their behalf.
4 A DNRO is only valid in Florida; it may not be recognized if the patient is outside the state.
5 The DNRO form has a specific yellow color to make it easily recognizable by healthcare providers, although a photocopy or a digital version is also legally valid.
6 For the DNRO to be considered valid, it must be signed by a Florida licensed physician, who also attests that the patient, or their legal representative, has been fully informed of what the DNRO signifies.
7 This order does not affect other forms of medical interventions, meaning healthcare providers can still administer treatments other than CPR to comfort or support the patient.
8 To cancel the DNRO, the patient or their representative needs to physically destroy the form or inform healthcare providers verbally or in writing.
9 The presence of a DNRO does not affect the patient's insurance coverage or limit access to other forms of medical care aimed at improving the quality of life.

Florida Do Not Resuscitate Order: Usage Steps

The Florida Do Not Resuscitate (DNR) Order form is a legal document that informs medical personnel not to perform cardiopulmonary resuscitation (CPR) if an individual's heart stops or if they stop breathing. This is a critical choice for individuals who want to ensure that their wishes regarding end-of-life care are respected. Filling out this form requires careful consideration and an understanding of what it entails. Following the right steps in completing the form ensures that the individual's preferences are clearly communicated and legally binding. Here are the necessary steps to fill out the Florida DNR Order form accurately.

  1. Gather Personal Information: Prepare by having your full legal name, date of birth, and address ready. This basic but crucial information identifies you as the person making the DNR request.
  2. Consult with a Healthcare Professional: Before completing the form, it's advisable to discuss your decision with a doctor or healthcare provider. They can explain the implications of a DNR order and ensure it aligns with your healthcare goals.
  3. Complete the Form: Enter your personal information in the designated areas on the form. Make sure all details are accurate and legible to avoid any confusion or ambiguity.
  4. Signature: The form must be signed by you, or if you are unable to do so, a legal representative can sign on your behalf. This signature is a crucial step as it validates the document.
  5. Physician's Signature: For the DNR order to be valid, a licensed physician must also sign the form. This signature indicates that the physician acknowledges your decision and verifies your current health status and understanding of the DNR order's implications.
  6. Witness Signatures: Some versions of the form require witness signatures. If this applies, two adults need to witness you or your representative signing the form. They cannot be the healthcare provider or the proxy signing the document. The witness's role is to verify the authenticity of the signing process.
  7. Keep the Form Accessible: Once the form is completed and signed, it should be kept in a location where it can be easily found by family members or medical personnel. Consider informing close family members, your healthcare proxy, or your attorney about where the form is kept.
  8. Inform Healthcare Providers: Make sure that your primary healthcare provider and any specialists are aware of your DNR order and have a copy on file. This ensures that in case of an emergency, your wishes are known and can be acted upon promptly.

Completing a Florida Do Not Resuscitate Order form is a personal decision that carries significant implications for how one's medical care is handled in critical moments. It is important to approach this process thoughtfully, ensuring every step is followed carefully to ensure that the document reflects your wishes accurately and is recognized as valid by medical personnel. It is also advisable to periodically review and, if necessary, update the DNR order to ensure it continues to reflect your current healthcare preferences.

Listed Questions and Answers

  1. What is a Do Not Resuscitate (DNR) Order in Florida?

    A Do Not Resuscitate Order in Florida is a legal document that tells medical professionals not to perform cardiopulmonary resuscitation (CPR) if a person's breathing stops or if the heart stops beating. It is a decision made by a person or their legal representative to refuse resuscitation in those critical moments.

  2. Who can establish a DNR Order in Florida?

    Any competent adult can request a DNR Order for themselves. A legal guardian or healthcare proxy can also request it on behalf of someone who is not able to make medical decisions for themselves, provided they have the legal authority to do so.

  3. How can you obtain a DNR Order in Florida?

    To obtain a DNR Order in Florida, one must consult with a healthcare provider. The healthcare provider can help fill out the necessary DNR form, which must then be signed by both the patient (or their authorized representative) and the healthcare provider. Once signed, it should be kept in a place where it is easily accessible to emergency personnel, like in the wallet or refrigerator.

  4. Is the Florida DNR Order valid in other states?

    While some states may honor a Florida DNR Order, it is not guaranteed. Different states have different requirements and forms. It’s advisable for individuals to check the specific laws in any state they plan to visit or move to.

  5. Can a DNR Order be revoked?

    Yes, a DNR Order can be revoked at any time by the individual for whom it was established. The revocation can be done verbally or in writing. If available, destroying the physical DNR form and informing any healthcare providers of the change is recommended.

  6. What is the difference between a DNR and a Living Will?

    A DNR is a specific instruction not to perform CPR in the event of cardiac or respiratory arrest. A Living Will, on the other hand, is a broader document that outlines a person's preferences for a variety of medical treatments and interventions in the event they are unable to communicate them due to illness or incapacity. While a DNR deals specifically with resuscitation, a Living Will addresses many more potential medical scenarios.

  7. Does a DNR affect other medical treatments?

    No, a DNR Order only applies to cardiopulmonary resuscitation (CPR). Other life-sustaining treatments or interventions, such as artificial nutrition, hydration, antibiotics, and pain relief, are not affected by a DNR and may be administered according to the patient's wishes or best medical practices. The intent of a DNR is only to decline CPR in case of cardiac or respiratory arrest.

Common mistakes

In the specific context of drafting a Florida Do Not Resuscitate (DNR) Order form, individuals often navigate a complex legal and medical landscape. Careful attention to detail is paramount when completing this document to ensure that a person's wishes concerning resuscitation are respected and legally recognized. Failure to adhere to the prescribed guidelines may result in the DNR order being invalid, which can lead to unwanted medical interventions in critical moments. Common mistakes include:

  1. Not using the correct form: The State of Florida has a specific form that must be used for a DNR order to be considered valid. A common mistake is using an outdated form or a template from another state, which can lead to the document not being recognized by medical personnel.
  2. Incorrectly signing or witnessing the document: Florida law requires that the DNR order be signed by the individual (or their legal surrogate) and witnessed by two individuals. Often, signatures are either missing or incorrectly witnessed, which compromises the document's legitimacy. Witnesses must not be the person’s spouse or blood relative, a detail often overlooked.
  3. Incomplete information: Every field on the DNR form needs to be meticulously filled out. Leaving sections incomplete can result in the form not being processed or recognized. This includes accurately providing personal identification details, the date, and necessary medical information.
  4. Failing to communicate with healthcare providers: After completing and signing the DNR order, it must be communicated and shared with the individual’s healthcare providers. Failure to distribute the DNR order to relevant medical personnel, including primary care physicians and local hospitals, often leads to emergency medical services being unaware of the patient’s wishes.

Understanding and avoiding these common errors can significantly impact the effectiveness and enforceability of a Florida Do Not Resuscitate Order. Individuals should not only pay close attention to the completion of this form but also consult with legal and medical professionals to ensure compliance with state requirements and personal healthcare goals.

Documents used along the form

In Florida, the Do Not Resuscitate Order (DNRO) form is a crucial document for those who wish to express their desire not to receive cardiopulmonary resuscitation (CPR) in the event their heart or breathing stops. However, this form is often accompanied by other important legal documents that help ensure a person’s healthcare wishes are fully understood and respected. Below is a list of other forms and documents that are commonly used alongside the Florida DNRO form. These documents play significant roles in managing healthcare decisions, financial matters, and other personal affairs.

  • Living Will: A document that outlines a person's wishes regarding medical treatment if they become unable to communicate or make decisions due to serious illness or incapacitation. It often specifies the types of life-sustaining treatments they do or do not want.
  • Health Care Surrogate Designation: This form allows a person to appoint someone else (a surrogate) to make healthcare decisions on their behalf if they become unable to do so. The surrogate's authority can include decisions beyond those related to life-prolonging treatments.
  • Power of Attorney (POA): A legal document granting someone the authority to act on another person’s behalf in a variety of matters, which can include financial, legal, and health-related decisions, depending on the type of POA.
  • HIPAA Authorization Form: Allows healthcare providers to disclose an individual’s health information to specified third parties. This is essential for the health care surrogate or anyone else the person wants to have access to their medical records.
  • Living Trust: A living trust is created during a person's lifetime and can be used to hold and manage their assets. It helps manage the estate and can ensure a smoother transition of asset distribution upon their death, often avoiding probate.
  • Organ and Tissue Donation Registration: A form that allows individuals to record their wishes about organ and tissue donation upon death. This can be aligned with one's values and wishes regarding their body after death.
  • Funeral Planning Declaration: A document where individuals can outline their preferences for their funeral arrangements, including burial or cremation, type of ceremony, and other related wishes. It helps ensure that their final arrangements are made according to their preferences.

When taken together, these documents provide a comprehensive approach to end-of-life planning. By addressing healthcare decisions, financial affairs, and personal preferences, individuals can offer clear guidance to their loved ones and healthcare providers, ensuring that their wishes are respected and followed. It’s advisable to consult with legal and healthcare professionals when preparing these documents to ensure they are completed accurately and reflect the individual’s wishes appropriately.

Similar forms

  • Living Will: This document, like a Do Not Resuscitate (DNR) order, outlines a person's preferences for medical treatment in situations where they are unable to make decisions for themselves. While a DNR specifically addresses the use of CPR, a living will can cover a broader range of medical interventions.

  • Advanced Healthcare Directive: This is an umbrella term that includes DNR orders but also encompasses other forms of directives, such as living wills and medical power of attorney. It's a legal tool that allows individuals to outline their medical care preferences and appoint someone to make healthcare decisions on their behalf if they're incapacitated.

  • Medical Power of Attorney (Healthcare Proxy): Similar to a DNR in its forward-looking perspective on medical care, this document designates a person to make health-related decisions for the grantor, should they become unable to communicate their wishes. It covers broader decision-making power beyond the scope of CPR and resuscitation.

  • Physician Orders for Life-Sustaining Treatment (POLST): More detailed than a DNR, a POLST is designed for seriously ill patients and covers a wide range of life-sustaining treatments, not just resuscitation. It turns the individual's treatment preferences into medical orders.

  • Health Insurance Portability and Accountability Act (HIPAA) Authorization Form: Though primarily concerned with the privacy and sharing of a person's medical records, it is similar to a DNR in the sense that it can be instrumental in executing a person's medical treatment wishes by ensuring the right people have access to the necessary information.

  • Organ Donor Card: Like a DNR, this indicates a specific medical-related preference, in this case, the decision to donate organs posthumously. Both documents guide medical personnel on how to proceed with the individual's body at critical moments.

  • Five Wishes Document: Comprehensive in nature, this document combines elements of a living will and health care power of attorney, adding personal, emotional, and spiritual wishes to the clinical directions typically found in a DNR. It provides a holistic approach to end-of-life planning.

  • Last Will and Testament: Although primarily focused on the distribution of an individual's estate after death, like a DNR, it is a critical component of end-of-life planning. It allows individuals to express their final wishes and make arrangements for their loved ones.

  • Hospital Discharge Plan: While not a legal document, a hospital discharge plan bears similarity in its forward-looking approach to a patient's care, much like a DNR. It outlines the care or treatment a patient should receive after leaving the hospital, ensuring continuity of care and preventing unnecessary readmissions.

Dos and Don'ts

Filling out the Florida Do Not Resuscitate Order (DNR) form is a critical process that requires careful attention to detail and accuracy. Here are essential dos and don'ts to consider when completing this form:

  • Do ensure the information provided is accurate and legible. Incorrect information can lead to unintended consequences during medical emergencies.
  • Do not fill out the form without consulting with a healthcare provider. A physician, osteopathic physician, or advanced practice registered nurse must discuss the implications and requirements before signing the form.
  • Do make sure the patient's full legal name is used. This helps healthcare professionals correctly identify the individual in emergency situations.
  • Do not use a photocopy of the form for official purposes. The original form, printed on yellow paper, is required to be recognized by emergency medical services (EMS).
  • Do have the form signed by the ordering physician, osteopathic physician, or advanced practice registered nurse. Their signature is crucial for the document's legality and enforceability.
  • Do not forget to date the form. The date provides essential information about when the DNR order was made, impacting its validity.
  • Do keep the DNR order in an easily accessible place. In case of an emergency, the form needs to be quickly found by EMS personnel or healthcare providers.
  • Do not alter the form after it has been filled out and signed. Any changes might void the form, requiring the process to start over with a new form.

By carefully following these guidelines, individuals can ensure that their wishes regarding resuscitation are understood and respected by healthcare professionals during critical moments.

Misconceptions

Understanding the Florida Do Not Resuscitate Order (DNR) form is crucial for individuals making informed health care decisions. However, several misconceptions surround its use and implications. It's important to clear these up to ensure everyone's wishes regarding lifesaving treatments are understood and respected.

  • A DNR is the same as a living will: This is not true. A DNR specifically addresses the issue of not receiving CPR (cardiopulmonary resuscitation) should your heart stop or you stop breathing. A living will, however, covers a broader range of end-of-life care decisions.

  • Doctors can overrule a DNR: In Florida, a valid DNR signed by the patient (or their legal representative) and a physician must be honored by healthcare providers, and they cannot legally overrule it without facing potential legal consequences.

  • You need a lawyer to complete a DNR: While legal advice might be beneficial in understanding all aspects of end-of-life decisions, one does not need a lawyer to fill out a Florida DNR form. It must be completed and signed by the patient or their legal representative and their physician.

  • Any family member can create a DNR for a relative: Only the patient or their legally appointed health care surrogate has the authority to approve a DNR. This decision cannot be randomly delegated to any family member without the proper legal documentation.

  • A DNR is effective in any setting: A Florida DNR is primarily intended for use in healthcare facilities. In some instances, for it to be valid outside of these settings, specific criteria and acknowledgments are required, so it's essential to understand the limitations and conditions under which your DNR operates.

  • Once signed, a DNR is permanent: This is incorrect. A DNR can be revoked at any time by the patient or their authorized representative, ensuring that individuals can change their minds as circumstances or their wishes evolve.

  • A DNR covers all forms of medical treatment: A common misunderstanding is that a DNR restricts all medical interventions. In reality, it only concerns measures necessary to revive someone when their breathing or heart stops. Other forms of care, including pain relief, oxygen, and comfort measures, are not governed by a DNR and can still be provided.

Clearing up these misconceptions is essential for ensuring that all individuals are empowered to make informed decisions about their health care preferences. It's also a reminder of the importance of discussing these preferences with family, healthcare surrogates, and healthcare providers to ensure wishes are understood and respected.

Key takeaways

The Florida Do Not Resuscitate (DNR) Order form is a critical document for those wishing to express their wishes regarding resuscitation in the event of respiratory or cardiac arrest. Understanding the key aspects of this form can empower individuals and their families to make informed decisions about their healthcare. Here are six essential takeaways about filling out and using the Florida DNR Order form:

  • Eligibility criteria must be met: The individual for whom the DNR order is intended must be of legal age or a legally authorized guardian, healthcare surrogate, or proxy may complete the form on behalf of a minor or an incapacitated adult, ensuring the patient's wishes are adhered to even when they cannot express them themselves.
  • Form completion requires specifics: Accurate completion of the form includes the patient's full name, date of birth, and a clear statement that cardiopulmonary resuscitation (CPR) should not be attempted. This declaration avoids any ambiguity during a medical emergency, ensuring the patient's wishes are honored.
  • Legal validation is crucial: A signature is required from the patient or their legal representative, along with the signature of a Florida-licensed physician, to validate the DNR order. This dual-signature requirement affirms that both the patient is informed and the physician acknowledges the patient's wishes.
  • Visibility is key: Once completed and signed, the DNR order should be kept in a location that is easily accessible to emergency responders. Common practices include placing the original or a copy in a conspicuous location within the home or carrying a wallet-sized version of the order.
  • Communication ensures compliance: It is important to discuss the existence and location of the DNR order with family members and any in-home caregivers. Informing them ensures they know the patient's wishes and can guide emergency personnel to the order during a crisis.
  • Understand the scope of the DNR: The Florida DNR Order specifically addresses the non-initiation of CPR in the event of cardiac or respiratory arrest. It does not affect other treatments, such as pain relief, nutrition, hydration, or other forms of medical care not related to resuscitation efforts.
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