Attorney-Approved  Do Not Resuscitate Order Document for Florida Prepare Document Here

Attorney-Approved Do Not Resuscitate Order Document for Florida

A Florida Do Not Resuscitate Order form is a legal document used to inform medical personnel that a patient does not wish to receive cardiopulmonary resuscitation (CPR) in the event that their breathing stops or their heart ceases to beat. This document is an important aspect of end-of-life planning, ensuring that an individual's wishes are respected during critical moments. To make your preferences known and ensure that your healthcare desires are followed, fill out the form by clicking the button below.

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In Florida, the issue of end-of-life care brings forth the critical importance of understanding and utilizing the Do Not Resuscitate Order form. This document stands as a testament to the wishes of individuals who, in the face of serious health crises, opt not to receive cardiopulmonary resuscitation (CPR) or other life-sustaining treatments. It touches upon deeply personal and sensitive matters, necessitating clarity, legality, and respect for the patient's autonomy. The form’s significance extends into the realm of healthcare, where professionals rely on it to guide their actions in accordance with the expressed desires of their patients. Given its profound impact, the process of acquiring, completing, and maintaining the validity of the form requires attention to detail and an understanding of Florida's specific regulations. Designed to ensure that individuals retain control over their medical treatment, the form acts not only as a medical directive but also serves to alleviate the emotional and ethical burdens on families and healthcare providers when facing difficult decisions. Its proper use is thus essential for anyone wishing to make their healthcare wishes known in advance, highlighting the intersection of law, medicine, and personal values in end-of-life care.

Sample - Florida Do Not Resuscitate Order Form

Florida Do Not Resuscitate Order (DNR)

This document is prepared in accordance with the guidelines outlined in the Florida Statutes, specifically within the framework of the Florida Do Not Resuscitate Order Act. Its purpose is to inform medical professionals about an individual's decision not to receive cardiopulmonary resuscitation (CPR) in the event that their breathing stops or if their heart stops beating. This directive is legally binding in the state of Florida and must be respected by health care providers.

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

Patient Information

  • Full Name: _______________
  • Date of Birth: _______________
  • Address: _______________
  • City: _______________ State: FL Zip Code: _______________
  • Phone Number: _______________

Do Not Resuscitate Request

I, _______________ (the above-named patient), hereby request that no resuscitation efforts, including CPR, be initiated or continued on me in case my breathing ceases or my heart stops beating. This request is made fully understanding the consequences of such a decision.

Physician Information

  • Physician's Name: _______________
  • License Number: _______________
  • Address: _______________
  • City: _______________ State: FL Zip Code: _______________
  • Phone Number: _______________

Signature Section

This section must be completed to validate the Do Not Resuscitate Order.

Patient's Signature: _______________ Date: _______________

If the patient is unable to sign, a legal representative may sign on their behalf.

Legal Representative's Signature: _______________ Date: _______________

Relationship to Patient: _______________

Physician's Signature: _______________ Date: _______________

The signing of this document by the physician indicates their agreement and understanding of the patient's wishes as stated herein.

Instructions for Use

This Do Not Resuscitate Order must be reviewed annually and reissued for it to remain valid. Keep the original document in a location where it can easily be accessed by emergency responders or healthcare providers. It is also advisable to discuss your wishes with family members and your primary care physician to ensure they are aware of and understand your directive.

Revocation of the Order

This Do Not Resuscitate Order can be revoked by the patient or their legal representative at any time, through a written revocation or by physically destroying the document. Notification of the revocation should be given to all relevant parties, including but not limited to healthcare providers and family members.

Document Specifications

Fact Description
Definition A Florida Do Not Resuscitate Order (DNRO) form is a legal document that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient's heart stops beating.
Applicable Law The form is governed by Florida Statute 765.401, also known as the 'Florida Do Not Resuscitate Act'.
Form Requirements To be valid, the DNRO must be on yellow paper, signed by the patient (or their legally authorized representative) and a Florida licensed physician, osteopathic physician, or advanced practice registered nurse.
Effectiveness The DNRO is effective immediately upon execution and remains in effect until the patient revokes it or passes away. It is applicable both in hospital settings and in other settings such as the patient's home.
Revocation A patient or their authorized representative can revoke the DNRO at any time, through any means that communicates the intention to revoke, without requiring any formal procedure.

Detailed Instructions for Using Florida Do Not Resuscitate Order

In Florida, filling out a Do Not Resuscitate Order (DNRO) form is a significant step for individuals who wish to make clear their wishes regarding resuscitation in the event of a respiratory or cardiac arrest. This document communicates a person's decision not to receive cardiopulmonary resuscitation (CPR) if their heart stops beating or they stop breathing. This form must be completed accurately to ensure that the individual's wishes are respected by healthcare providers. The following instructions will guide you through the process of filling out the Florida DNRO form.

  1. Obtain the latest version of the Florida Do Not Resuscitate Order form from the Florida Department of Health's website. Make sure you are using the most current form.
  2. Read the form thoroughly before beginning to fill it out. Understanding the form's content and its implications is crucial for making an informed decision.
  3. Enter the full legal name of the individual (the patient) for whom the DNRO applies in the space provided.
  4. Fill in the patient's date of birth using the format MM/DD/YYYY.
  5. Provide the patient's home address, including the city, state, and zip code.
  6. If applicable, include the name and address of the healthcare surrogate or the legally appointed guardian. This information should be entered if the patient has designated someone to make healthcare decisions on their behalf.
  7. Review the statement regarding the withholding of cardiopulmonary resuscitation, which explains what the DNRO does. Ensure that the patient or their legally authorized representative agrees with this statement.
  8. The patient or their authorized representative must sign and date the form. If the patient is unable to sign, a legal representative, healthcare surrogate, or proxy can sign on the patient's behalf.
  9. A physician must also sign and date the form, affirming their agreement with the DNRO's orders and verifying the patient's decision. The physician's license number should also be included.
  10. Keep the original signed DNRO form in a location that is easily accessible to emergency personnel or healthcare providers. It's advisable to inform family members, close friends, and healthcare providers of the form's existence and its location.

Completing the Florida Do Not Resuscitate Order form is a profound decision that reflects an individual's healthcare preferences. Once filled out, it is important to communicate these wishes to all parties involved to ensure that the patient's desires are honored in critical moments. By following these steps carefully, individuals can accurately complete their DNRO form and have peace of mind knowing their wishes are clearly documented.

Common Questions

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

A Florida Do Not Resuscitate Order (DNRO) form is a legal document that tells healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a person's breathing stops or if the heart stops beating. This form is used by those who do not wish to receive CPR in these emergency situations. It is signed by the person (or their legal representative) and their physician, advanced practice registered nurse (APRN), or physician assistant (PA) to be valid.

Who can sign a DNRO form in Florida?

The DNRO form must be signed by the person for whom it is intended or their legally authorized representative, such as a healthcare surrogate or durable power of attorney for healthcare. Additionally, it requires the signature of a Florida-licensed physician, an advanced practice registered nurse (APRN), or a physician assistant (PA) who is familiar with the person’s medical condition and who agrees that the DNRO is appropriate for their medical circumstances.

Where should the DNRO form be kept?

To ensure the DNRO form is respected, it should be kept in a place where it can be easily found and presented in case of an emergency. Suggested locations include:

  • With the person, in a wallet or purse
  • In the home, on or near the refrigerator, or in a visible location in the living area
  • With the person's primary care physician or specialist's medical records
  • In the possession of a healthcare surrogate or family member who is often present

This ensures that in an emergency, the form can be quickly found by emergency responders.

Can a DNRO form be revoked?

Yes, a DNRO form can be revoked at any time by the person for whom it was created or their legal representative. Revocation can be done in several ways:

  1. Telling a healthcare provider directly that they want to revoke it.
  2. Destroying the form itself or having someone else destroy it on their behalf.
  3. Writing a revocation statement.

Once revoked, it is important to communicate this change to any healthcare providers, family members, or others who were aware of the original DNRO to ensure that the person’s current wishes are known and respected.

Common mistakes

  1. Not ensuring that all required personal information is complete and accurate. This includes the patient's full name, date of birth, and address. Missing or incorrect information can invalidate the document.

  2. Failing to have the form signed by the required parties. The Florida Do Not Resuscitate Order (DNRO) form must be signed by the patient, or their legally authorized representative if the patient is unable to do so. The absence of these signatures results in the form not being legally binding.

  3. Overlooking the need for a physician’s signature. The DNRO form requires the signature of a Florida-licensed physician, physician's assistant, or advanced practice registered nurse who attests to the patient's condition and the DNRO's appropriateness. Without this, the form is not valid.

  4. Using an outdated version of the form. The state of Florida periodically updates the DNRO form to reflect current laws and regulations. Utilizing an old form can lead to the DNRO being considered invalid.

  5. Not making sufficient copies of the completed form. The patient should ensure copies are readily available to family members, caregivers, and health care providers. Lack of accessibility can hinder the form's intent during an emergency.

  6. Ignoring the need to review and possibly update the form regularly. A patient’s medical condition and preferences might change, necessitating an update to their DNRO form. An outdated form might not accurately reflect the patient’s current wishes.

Documents used along the form

When preparing for future healthcare situations, it's important to have a comprehensive plan in place. While a Florida Do Not Resuscitate Order form is a critical component for those who wish to specify their desires concerning resuscitation efforts, several other documents can complement this directive and provide a more detailed picture of one's healthcare preferences. These forms can ensure that an individual's healthcare wishes are respected and clearly understood by family members and healthcare providers.

  • Living Will: This document allows individuals to outline their preferences regarding the types of medical treatment they want to receive or refuse in the event they are unable to communicate their wishes themselves.
  • Health Care Surrogate Designation: Through this form, a person can appoint another individual to make healthcare decisions on their behalf if they are incapacitated and unable to make these decisions on their own.
  • Advance Directive: An advance directive incorporates aspects of both a living will and a health care surrogate designation, providing instructions about healthcare preferences and appointing a decision-maker.
  • Durable Power of Attorney: This legal document allows an individual to designate another person to make financial and other decisions on their behalf, which can be crucial if they become unable to manage their affairs.
  • HIPAA Release Form: The Health Insurance Portability and Accountability Act (HIPAA) Release Form grants permission for healthcare providers to share an individual’s medical information with designated persons, facilitating better communication among caregivers and family members.
  • Physician Orders for Life-Sustaining Treatment (POLST): Similar to a Do Not Resuscitate Order but more comprehensive, this form includes instructions for other life-sustaining treatments beyond cardiopulmonary resuscitation (CPR).
  • Organ and Tissue Donation Registration: This document allows individuals to express their wishes regarding organ and tissue donation after death, which can be an important component of end-of-life planning.
  • Last Will and Testament: Although not directly related to healthcare decisions, this legal document is critical for expressing one's wishes regarding the distribution of assets and care of dependents after death.

Incorporating these documents into your healthcare planning can provide a well-rounded approach to ensuring your wishes are known and respected. Together, they offer a framework for loved ones and healthcare providers to understand and honor your healthcare and personal preferences, making a difficult time a little easier for everyone involved.

Similar forms

The Florida Do Not Resuscitate Order (DNRO) form shares similarities with an Advance Directive, in that both documents empower individuals to make choices about their future healthcare. Whereas a DNRO specifically instructs healthcare providers not to perform CPR in the event the individual's breathing or heartbeat stops, Advance Directives can cover a wider array of medical treatments and interventions an individual wishes or does not wish to receive in the event of incapacitation. Advance Directives often include living wills, which articulate a person's desires regarding life-sustaining treatments, and durable power of attorney for healthcare, where an individual designates another person to make healthcare decisions on their behalf should they become unable to do so.

Similarly, a Living Will mirrors the intent behind a DNRO by enabling a person to outline their healthcare preferences, particularly regarding end-of-life care. While a Living Will encompasses broader healthcare decisions, such as the refusal of certain life-sustaining treatments like artificial nutrition and hydration, the DNRO is narrowly focused on the act of not initiating cardiopulmonary resuscitation (CPR). Both documents serve as critical tools in the realm of personal healthcare planning, ensuring that a person's medical treatment preferences are known and respected when they can't speak for themselves.

A Healthcare Proxy is another document that shares common ground with the Florida Do Not Resuscitate Order. It allows individuals to appoint a trusted person, known as an agent or proxy, to make healthcare decisions on their behalf in the event they become incapacitated. While the DNRO has a specific focus—preventing emergency medical personnel from performing CPR—a Healthcare Proxy has a broader scope, enabling the proxy to make a range of healthcare decisions. This can include decisions about life support, surgery, and other medical treatments, in accordance with the wishes of the individual.

The Five Wishes Document, though broader in scope, relates to the DNRO by addressing end-of-life care preferences. It goes beyond medical issues to address personal, emotional, and spiritual needs, thus providing a comprehensive framework for discussing and documenting one's desires for end-of-life care. While the DNRO explicitly states one's wishes regarding CPR, the Five Wishes Document offers a broader exploration of one's values and desires in the context of illness, dying, and death. It helps individuals communicate how they want to be treated, who they want by their side, and what they want their loved ones to know as they approach the end of their life.

Lastly, the Medical Order for Life-Sustaining Treatment (MOLST) or Physician Orders for Life-Sustaining Treatment (POLST) form is closely related to the Florida DNRO. These forms are medical orders that apply to a broader range of life-sustaining treatments beyond CPR, including intubation, mechanical ventilation, and other forms of medical intervention. Similar to the DNRO, MOLST or POLST forms are designed to ensure that an individual’s wishes regarding life-sustaining treatments are understood and honored by healthcare professionals across settings, whether in a hospital, at home, or in a hospice. However, the DNRO is specific to CPR, while MOLST or POLST encompass a wider array of medical interventions.

Dos and Don'ts

When you're considering filling out a Do Not Resuscitate (DNR) Order form in Florida, it's vital to approach the process with care. A DNR order is a serious and personal decision that requires understanding and thoughtfulness. Here are ten things you should and shouldn't do:

Things You Should Do
  1. Read the entire form carefully to ensure you understand what a DNR order entails and how it will affect emergency medical treatment.

  2. Discuss your decision with close family members, loved ones, or a healthcare proxy to make sure they understand your wishes.

  3. Consult with your healthcare provider to get professional insight on how a DNR order aligns with your health status and personal values.

  4. Ensure all required fields on the form are filled out correctly, including your full legal name and date of birth, to prevent any misunderstandings.

  5. Sign the form in the presence of the required witnesses, if applicable, as their signatures may also be needed for the form to be valid.

Things You Shouldn't Do
  • Don't fill out the form in haste without fully understanding the implications of a DNR order.

  • Don't leave any part of the form blank, thinking it's not important—every section is necessary to ensure the DNR order is understood and followed correctly.

  • Don't forget to communicate your decision and provide copies of the DNR order to relevant parties, such as family members and healthcare providers.

  • Don't neglect to review and update your DNR order if your health situation changes or if you have a change of heart.

  • Don't sign the form without ensuring that the witness criteria (if required) are met, as failing to do so may invalidate the document.

Remember, the decision to have a DNR order is personal and should be made with full awareness of its consequences. It's essential to take the steps that will make the process as clear and straightforward as possible for everyone involved.

Misconceptions

Understanding the Florida Do Not Resuscitate Order (DNRO) form is crucial, but there are several misconceptions surrounding its use and implications. By addressing these, individuals can make more informed decisions regarding their healthcare preferences.

  1. It applies in all situations: A common misconception is that a Do Not Resuscitate Order applies to every medical situation. However, it is specific to circumstances where an individual is experiencing cardiac arrest or respiratory failure. It does not apply to other medical treatments or interventions.

  2. Only the elderly or terminally ill can have it: People often think that DNROs are only for the elderly or those with terminal illnesses. In truth, any competent adult can request a DNRO based on their personal healthcare preferences and consultations with their healthcare providers.

  3. It requires family consent: The belief that family members must consent to a DNRO is incorrect. While discussing healthcare preferences with family is important, the decision to have a DNRO rests solely with the individual or their legally designated healthcare surrogate.

  4. It's irreversible: Another misconception is that once a DNRO is signed, it cannot be revoked. In reality, the individual or their surrogate can revoke the order at any time through various means, such as physically destroying the form or verbally expressing the wish to revoke it to a healthcare provider.

  5. A lawyer must prepare it: Many believe that a lawyer must prepare the DNRO form. However, Florida law does not require legal assistance to complete a DNRO. The form must be signed by the individual (or their surrogate) and a physician to be valid.

  6. It guarantees no hospital admission: Some people think having a DNRO means they will not be admitted to the hospital under any circumstances. This is not the case; the DNRO specifically relates to not receiving CPR, while other medical care can still be provided based on the individual's needs and wishes.

  7. It's the same as a living will: Confusing a DNRO with a living will is common. A living will is a broader document that can cover a range of end-of-life care decisions. In contrast, a DNRO is specifically about not receiving cardiopulmonary resuscitation.

  8. It must be kept in a secret place: Keeping a DNRO hidden is actually counterproductive. It should be readily accessible and shared with a person's healthcare providers and family to ensure that it is respected in case of an emergency.

  9. It leads to lower quality care: There's a false belief that having a DNRO results in receiving lower quality care. Healthcare professionals are committed to providing the best possible care, respecting patients' wishes regarding life-sustaining treatment like CPR.

Clearing up these misconceptions about the Florida Do Not Resuscitate Order form allows individuals to make choices that align with their values and healthcare goals. It's always recommended to discuss these decisions with healthcare providers and loved ones.

Key takeaways

Filling out and using the Florida Do Not Resuscitate (DNR) Order form is a critical step for individuals who wish to make their end-of-life care wishes known in advance. The process involves several key elements to ensure that the document is valid and will be followed by healthcare professionals when the time comes. Here are ten important takeaways about this vital document:

  1. The Florida DNR Order form must be filled out correctly and entirely to be considered valid. Every section requires attention to detail to avoid any ambiguity regarding the individual's wishes.

  2. This form is legally binding and tells healthcare professionals not to perform cardiopulmonary resuscitation (CPR) if the person's breathing or heart stops.

  3. It's essential for the form to be signed by a licensed Florida physician, as their signature confirms the patient's informed decision and the medical appropriateness of the DNR order.

  4. The individual or their legally authorized representative can initiate the request for a DNR order, but it must always involve a discussion with a healthcare provider to ensure understanding and consent.

  5. For the form to be effective, it must be readily available to emergency medical personnel or hospital staff. This often means keeping it in a visible and accessible location.

  6. The DNR order serves only to refuse CPR, not other forms of medical intervention. Individuals can still receive medication, oxygen, or other procedures to provide comfort and relieve pain.

  7. A DNR order can be revoked at any time by the individual or their legal representative. This action should be communicated immediately to the healthcare provider and documented accordingly.

  8. It's crucial to discuss and share the existence of a DNR order with family members and caregivers to ensure that everyone understands the person's wishes, reducing potential conflicts or misunderstandings during an emergency.

  9. Florida’s DNR order is specific to the state. When traveling or moving, check the requirements and validity of the DNR in the new location, as laws and forms can differ from state to state.

  10. Regularly review and update the DNR order to ensure it reflects the current wishes of the individual. Changes in health status or personal preferences might necessitate adjustments to the order.

Thoughtful consideration and thorough planning are required when filling out and utilizing the Florida DNR Order form. It ensures that the individual's end-of-life wishes are respected, providing peace of mind to all involved. Consulting with healthcare legal professionals can also provide guidance and help navigate the complexities of this important document.

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