Valid  Do Not Resuscitate Order Template for Florida

Valid Do Not Resuscitate Order Template for Florida

A Florida Do Not Resuscitate Order (DNRO) is a legal document that allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. This form is crucial for ensuring that a person's preferences about life-saving measures are respected when they are unable to communicate. Understanding how to properly complete and use this form can provide peace of mind for both individuals and their families.

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The Florida Do Not Resuscitate Order (DNRO) form serves as a critical document for individuals who wish to express their preferences regarding medical treatment in the event of a life-threatening situation. Designed to ensure that a person's wishes are respected, this form allows patients to decline cardiopulmonary resuscitation (CPR) and other life-saving measures. It is important to understand that the DNRO is not a blanket refusal of all medical care; rather, it specifically addresses resuscitation efforts. To be valid, the form must be completed and signed by a qualified healthcare provider, and it should be readily accessible to emergency medical personnel. Additionally, the DNRO must be signed by the patient or their legal representative, ensuring that the decision reflects the individual's values and desires. Understanding the implications of this form is essential for both patients and their families, as it provides clarity during challenging times and helps guide medical decisions in accordance with the patient's wishes.

Florida Do Not Resuscitate Order Sample

Florida Do Not Resuscitate Order Template

This Do Not Resuscitate (DNR) Order is compliant with Florida Statutes, Section 401.45. It documents the desire of the individual to decline resuscitation in the event of cardiac or respiratory arrest.

Please fill out the following information:

  • Patient's Full Name: ___________________________
  • Date of Birth: ___________________________
  • Medical Record Number: ___________________________
  • Primary Physician's Name: ___________________________
  • Primary Physician's Phone Number: ___________________________

In accordance with Florida law, the patient or their legally authorized representative must sign below to indicate consent:

  • Patient's Signature: ___________________________
  • Date: ___________________________
  • Legally Authorized Representative's Name (if applicable): ___________________________
  • Signature of Legally Authorized Representative: ___________________________
  • Date: ___________________________

This DNR Order shall be valid in all medical facilities and emergency medical services in Florida. Ensure that a copy of this order is kept on file in all relevant medical records and readily accessible to relevant healthcare providers.

Key takeaways

When filling out and using the Florida Do Not Resuscitate Order (DNRO) form, there are several important points to consider:

  • The DNRO form must be completed and signed by a licensed physician. This ensures that the order is valid and recognized by medical personnel.
  • It is essential to clearly indicate the patient's wishes regarding resuscitation. The form should be filled out accurately to avoid any confusion during medical emergencies.
  • The DNRO must be readily accessible. Keep a copy in a visible location, such as on the refrigerator or in the patient's medical records, to ensure it can be easily found when needed.
  • Regularly review the DNRO. Changes in health status or personal preferences may necessitate updates to the order.