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Consider Popular Do Not Resuscitate Order Forms for Specific States

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Florida Do Not Resuscitate Order Preview

Florida Do Not Resuscitate Order Template

This Do Not Resuscitate (DNR) Order is designed for use in the state of Florida, in compliance with Florida Statutes Section 401.45. This document expresses the individual’s wishes regarding resuscitation efforts in the event of cardiac arrest or respiratory failure.

By completing this form, you confirm that the individual named below does not wish to receive cardiopulmonary resuscitation (CPR) in the event of a medical emergency. Please ensure that this document is completed accurately and signed appropriately.

Patient Information:

  • Full Name: _______________________________
  • Date of Birth: _______________________________
  • Address: _______________________________
  • City: _______________________________
  • State: Florida
  • ZIP Code: _______________________________

Physician Information:

  • Full Name: _______________________________
  • Medical License Number: _______________________________
  • Address: _______________________________
  • Phone Number: _______________________________

Decision Maker (if applicable):

  • Full Name: _______________________________
  • Relationship to Patient: _______________________________
  • Address: _______________________________
  • Phone Number: _______________________________

Patient's Wishes:

I, the undersigned, request that in the event of a medical emergency involving cardiac arrest or respiratory failure, the above-named patient is not given cardiopulmonary resuscitation (CPR) or any further resuscitative measures. This decision has been made voluntarily and with full understanding of its meaning.

Signature of Patient: _______________________________

Date: _______________________________

Signature of Physician: _______________________________

Date: _______________________________

Witnesses (required):

  1. Full Name: _______________________________
  2. Signature: _______________________________
  3. Date: _______________________________
  1. Full Name: _______________________________
  2. Signature: _______________________________
  3. Date: _______________________________

Keep this document in a place that is easily accessible to your healthcare providers. Share copies with your family, loved ones, and healthcare team to ensure your wishes are honored.

Documents used along the form

The Florida Do Not Resuscitate Order (DNRO) form is an important document for individuals who wish to express their preferences regarding resuscitation in the event of a medical emergency. It is often accompanied by several other forms and documents that can help clarify a person's healthcare wishes. Here is a list of related forms that may be used in conjunction with the DNRO:

  • Advance Directive: This document allows individuals to outline their preferences for medical treatment and appoint a healthcare surrogate to make decisions on their behalf if they are unable to do so.
  • Transfer-on-Death Deed: This form allows property owners to designate beneficiaries who will receive their real estate upon their death, bypassing the probate process, and is crucial for effective estate planning; more information can be found at https://transferondeathdeedform.com/district-of-columbia-transfer-on-death-deed.
  • Healthcare Surrogate Designation: This form is used to appoint someone to make healthcare decisions for an individual if they become incapacitated. It is crucial for ensuring that a trusted person can advocate for one’s wishes.
  • Living Will: A living will specifies the types of medical treatment a person wishes to receive or not receive in the event of terminal illness or incapacitation. It complements the DNRO by providing additional guidance on end-of-life care.
  • Physician Orders for Life-Sustaining Treatment (POLST): This is a medical order that outlines a patient's preferences for life-sustaining treatments. It is more detailed than a DNRO and is intended for those with serious health conditions.
  • Do Not Hospitalize Order: This order expresses a person's wish to avoid hospitalization in certain situations, focusing on comfort care instead. It can be particularly relevant for individuals in hospice or palliative care.
  • Emergency Medical Services (EMS) Form: This form provides first responders with information about a patient's DNRO and other medical directives. It ensures that emergency personnel are aware of the patient's wishes.
  • Patient Advocate Form: This document designates an advocate to help communicate a patient’s wishes regarding medical treatment. It can be especially useful in complex medical situations.
  • Healthcare Power of Attorney: Similar to a healthcare surrogate designation, this document grants authority to a specific person to make healthcare decisions on behalf of the individual, often used when the individual is unable to communicate their wishes.

Having these forms and documents in place can help ensure that healthcare providers and loved ones understand and respect an individual's wishes regarding medical treatment. It is always advisable to review these documents regularly and update them as necessary to reflect any changes in preferences or circumstances.

Similar forms

  • Living Will: A living will outlines a person's preferences for medical treatment in situations where they cannot communicate their wishes. Like a Do Not Resuscitate Order, it provides guidance to healthcare providers about the patient's desires regarding life-sustaining measures.
  • Durable Power of Attorney for Healthcare: This document allows an individual to appoint someone else to make healthcare decisions on their behalf. It often includes instructions about resuscitation and other critical medical interventions, similar to a DNR.
  • Advance Healthcare Directive: An advance directive combines elements of a living will and a durable power of attorney. It specifies the types of medical treatment a person wishes to receive or avoid, including resuscitation efforts, making it comparable to a DNR.
  • Articles of Incorporation: Essential for businesses in Illinois, the Articles of Incorporation form lays the groundwork for legal structure and operational legitimacy, ensuring that the company is officially recognized by the state.
  • Physician Orders for Life-Sustaining Treatment (POLST): POLST is a medical order that outlines a patient’s preferences for life-sustaining treatment. It is designed for individuals with serious illnesses and is similar to a DNR in that it guides emergency medical personnel in critical situations.
  • Do Not Intubate Order: This order specifically instructs healthcare providers not to place a patient on a ventilator if they cannot breathe on their own. Like a DNR, it reflects the patient’s wishes regarding aggressive medical interventions.
  • Comfort Care Order: A comfort care order focuses on providing relief from pain and other distressing symptoms rather than prolonging life. It aligns with the principles of a DNR by prioritizing the patient's comfort over life-saving measures.

Misconceptions

Understanding the Florida Do Not Resuscitate (DNR) Order form is essential for making informed decisions about medical care. However, there are several misconceptions that can lead to confusion. Here are five common misconceptions:

  1. A DNR means no medical care will be provided. Many people believe that having a DNR in place means that all medical treatment will be withheld. In reality, a DNR specifically addresses resuscitation efforts, such as CPR, but does not prevent other forms of medical care from being administered.
  2. Only terminally ill patients need a DNR. While many think that DNR orders are only for those who are terminally ill, anyone can choose to have a DNR regardless of their health status. It’s a personal decision based on individual values and preferences regarding end-of-life care.
  3. A DNR is permanent and cannot be changed. Some individuals assume that once a DNR is signed, it cannot be altered. This is not true. A DNR can be revoked or modified at any time by the patient or their designated representative, ensuring that it reflects current wishes.
  4. All medical professionals recognize DNR orders. While DNR orders are legally binding, there may be instances where some medical professionals are not familiar with them or may not have access to the documentation. It’s crucial to communicate your wishes clearly and ensure that your DNR is easily accessible to your healthcare team.
  5. A DNR applies in all situations, including outside of medical facilities. Many people think that a DNR order is valid in every scenario, including at home or in public. However, DNR orders are generally recognized in medical settings. Outside of these environments, bystanders may not be aware of the DNR, so it’s important to communicate your wishes to family and friends.

By addressing these misconceptions, individuals can better understand the implications of a DNR order and make choices that align with their personal healthcare preferences.

Understanding Florida Do Not Resuscitate Order

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

    A Florida Do Not Resuscitate Order is a legal document that allows individuals to refuse resuscitation efforts in the event of a medical emergency. This means that if a person’s heart stops beating or they stop breathing, medical personnel will not attempt to revive them. The order is intended for those who wish to avoid aggressive life-saving measures, particularly in situations where recovery is unlikely or the individual’s quality of life would be severely compromised.

  2. Who can complete a DNRO?

    In Florida, any adult can complete a Do Not Resuscitate Order. This includes individuals who are capable of making their own medical decisions. Additionally, a legal guardian or a person with power of attorney may also complete the form on behalf of someone who is unable to do so. It is important that the individual understands the implications of the order before signing.

  3. How do I obtain a DNRO form?

    The DNRO form can be obtained from various sources. Healthcare providers, hospitals, and hospice organizations often have copies available. You can also find the form on the Florida Department of Health’s website. Once you have the form, it must be filled out completely and signed by the individual, or their authorized representative, and a physician. The physician’s signature is crucial as it validates the order.

  4. What should I do after completing the DNRO?

    After completing the DNRO, it is essential to keep the document in a safe but accessible place. Consider giving copies to your healthcare provider, family members, and anyone else who may need to know your wishes. Additionally, it’s wise to carry a wallet card indicating that you have a DNRO in place. This can help ensure that your wishes are respected in an emergency situation.

  5. Can a DNRO be revoked or changed?

    Yes, a Do Not Resuscitate Order can be revoked or changed at any time. If you decide to change your mind, simply notify your healthcare provider and destroy any copies of the previous DNRO. You can then complete a new DNRO form if you wish to establish different wishes regarding resuscitation. It’s important to communicate any changes to family members and caregivers to ensure everyone is aware of your current wishes.