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Additional State-specific Do Not Resuscitate Order Forms

Do Not Resuscitate Form - This document outlines your wishes regarding CPR and resuscitation efforts.

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Dnr Rules and Regulations - Communicating your end-of-life wishes through a DNR order can help in making difficult decisions easier.

Florida Do Not Resuscitate Order Sample

Florida Do Not Resuscitate Order Template

This Do Not Resuscitate Order (DNR) is executed in accordance with Florida Statutes, Chapter 401.605. This document is intended to communicate your wishes regarding resuscitation in the event of a medical emergency.

Patient Information:

  • Name: __________________________________
  • Date of Birth: __________________________
  • Address: _______________________________
  • City: ______________________________ State: __________ ZIP: __________
  • Phone Number: _________________________

Medical Information:

  • Health Care Provider Name: ______________
  • Health Care Provider Phone: ______________

Instructions:

I, the undersigned, voluntarily request that my health care providers, emergency medical personnel, and other caregivers not initiate cardiopulmonary resuscitation (CPR) or advanced life-support measures in the event of cardiac or respiratory arrest.

This order remains valid until:

  1. It is revoked in writing.
  2. A new DNR order is executed.

Signatures:

  • Patient Signature: ________________________ Date: __________
  • Medical Proxy (if applicable): ___________ Date: __________
  • Witness Signature: _______________________ Date: __________

By signing this document, you are confirming that you understand the implications of this Do Not Resuscitate Order and that it reflects your wishes for end-of-life care.

⇓ PDF File

Instructions on Utilizing Florida Do Not Resuscitate Order

Completing the Florida Do Not Resuscitate Order form is an important step for individuals who wish to express their medical preferences in critical situations. It is essential to ensure that all information is accurate and clearly presented. Following these steps will help guide you through the process of filling out the form correctly.

  1. Obtain the Florida Do Not Resuscitate Order form. You can find this form on the Florida Department of Health website or through healthcare providers.
  2. Start by entering your full name at the top of the form. Make sure to write it clearly to avoid any misunderstandings.
  3. Provide your date of birth. This helps to confirm your identity and ensure that the order is associated with the correct individual.
  4. Next, indicate your address. This should include your street address, city, state, and zip code.
  5. Designate a healthcare surrogate if you have one. If you do not have a surrogate, you can skip this step.
  6. In the designated section, clearly state your wishes regarding resuscitation. Use simple and direct language to express your preferences.
  7. Sign and date the form at the bottom. Your signature is essential for validating the order.
  8. Have the form witnessed by two individuals. They must be at least 18 years old and cannot be related to you or have any financial interest in your estate.
  9. Once completed, make copies of the signed form. Keep one for your records and provide copies to your healthcare provider and family members.

After filling out the form, ensure that it is stored in a safe place where it can be easily accessed in case of an emergency. Sharing copies with your healthcare provider and loved ones will help ensure that your wishes are respected.

Misconceptions

Understanding the Florida Do Not Resuscitate (DNR) Order form is crucial for individuals and families making healthcare decisions. Here are nine common misconceptions about this important document.

  1. A DNR means that no medical care will be provided.

    This is not true. A DNR specifically addresses resuscitation efforts in the event of cardiac arrest. Other forms of medical care, including pain management and comfort measures, will still be provided.

  2. Only terminally ill patients need a DNR.

    A DNR can be appropriate for anyone who wishes to refuse resuscitation, regardless of their health status. It is a personal choice based on individual values and preferences.

  3. A DNR is only valid in a hospital setting.

    In Florida, a DNR order is valid in both hospital and out-of-hospital settings. This means it applies to emergency responders and medical personnel outside of a healthcare facility.

  4. You can’t change your mind once you have a DNR.

    Individuals can revoke or modify their DNR orders at any time. It is essential to communicate any changes to healthcare providers and ensure that the most current document is available.

  5. A DNR is the same as a living will.

    While both documents relate to end-of-life decisions, they serve different purposes. A living will outlines preferences for medical treatment, while a DNR specifically addresses resuscitation efforts.

  6. All doctors will honor a DNR order.

    While most healthcare providers are trained to respect DNR orders, there may be instances where misunderstandings occur. It is important to ensure that all medical personnel are aware of the DNR status.

  7. A DNR order is only for older adults.

    Anyone, regardless of age, can have a DNR order. Young individuals with serious health conditions may also choose to have a DNR in place.

  8. You need a lawyer to create a DNR order.

    Creating a DNR order does not require legal assistance. However, it is advisable to consult with healthcare providers to ensure that the document meets all necessary requirements.

  9. Once signed, a DNR is permanent.

    A DNR order is not permanent. Individuals can change or revoke their DNR at any time, and it is important to keep the document updated and accessible.

By understanding these misconceptions, individuals can make informed decisions about their healthcare preferences and ensure that their wishes are respected.

Documents used along the form

The Florida Do Not Resuscitate Order (DNRO) form is a critical document for individuals who wish to communicate their preferences regarding resuscitation in the event of a medical emergency. However, it is often accompanied by other important forms and documents that help clarify a person's wishes regarding medical care and end-of-life decisions. Below is a list of six commonly used forms that complement the DNRO.

  • Advance Directive: This document outlines a person's preferences for medical treatment in situations where they are unable to communicate their wishes. It can include instructions on life-sustaining treatments, organ donation, and other healthcare decisions.
  • Durable Power of Attorney: This legal document allows an individual to grant authority to another person to make financial decisions on their behalf, ensuring that their affairs are managed according to their wishes even if they become incapacitated. For more information, check out the Durable Power of Attorney.
  • Health Care Surrogate Designation: This form allows individuals to appoint someone they trust to make healthcare decisions on their behalf if they become incapacitated. It ensures that their medical preferences are honored even when they cannot express them directly.
  • Living Will: A living will is a specific type of advance directive that details a person's wishes regarding medical treatments at the end of life. It typically addresses situations such as terminal illness or irreversible coma.
  • Physician Orders for Life-Sustaining Treatment (POLST): This form translates a patient's preferences for treatment into actionable medical orders. It is particularly useful for individuals with serious illnesses who want to ensure their treatment preferences are respected across different healthcare settings.
  • Do Not Intubate (DNI) Order: This order specifies that a patient does not wish to be intubated in the event of respiratory failure. It is often used in conjunction with a DNRO to provide clearer guidance on the extent of medical intervention desired.
  • Organ Donation Registration: This document allows individuals to express their wishes regarding organ donation after death. It can be registered with the state and ensures that a person's preferences are known and respected.

Understanding these forms and how they interact with the Florida Do Not Resuscitate Order is essential for ensuring that individuals' healthcare wishes are honored. It is crucial to have these documents in place to facilitate discussions with healthcare providers and loved ones, ultimately leading to more informed and respectful care decisions.