Free Florida Do Not Resuscitate Order Form

Free Florida Do Not Resuscitate Order Form

A Florida Do Not Resuscitate Order form is an official document that allows individuals to express their wishes concerning resuscitation efforts in case of a medical emergency. This form can provide clarity and direction for healthcare providers and families during critical moments. To ensure your preferences are respected, consider filling out the form by clicking the button below.

In the state of Florida, the Do Not Resuscitate Order (DNRO) form serves as an important legal document that allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. This form is designed for patients who have a clear understanding of their medical situation and wish to avoid life-sustaining treatments like cardiopulmonary resuscitation (CPR) when they are unable to communicate their decisions. A properly executed DNRO must include vital components such as the patient's information, physician's orders, and signatures from both the patient (or their legal representative) and the physician. It's crucial to ensure that the form is completed in accordance with Florida's legal requirements, as it can only be activated in a hospital or emergency medical services setting. Additionally, the DNRO must be readily accessible during medical emergencies to guide healthcare providers in adhering to the patient's preferences. Understanding how to complete and utilize this form empowers individuals to take control of their medical care in alignment with their personal values and end-of-life desires.

Document Sample

Florida Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is established in accordance with Florida Statute 401.45. This form grants permission to healthcare personnel not to perform resuscitation in the event of cardiac arrest.

Please complete the information below:

  • Patient's Full Name: ____________________________________________
  • Date of Birth: ________________________________________________
  • Address: _____________________________________________________
  • City: _________________________________________________________
  • State: ________________________________________________________(Florida)
  • ZIP Code: ___________________________________________________
  • Patient's Physician Name: _____________________________________
  • Physician's Contact Number: ___________________________________

The patient has the right to refuse resuscitation treatment. This order applies only to resuscitation efforts during cardiac arrest. It does not limit other medical treatments that the patient may desire.

Please indicate the following:

  • Signature of Patient or Legal Representative: ______________________
  • Date: _________________________________________________________

Witness Information:

  1. Witness 1 Name: _______________________________________________
  2. Witness 1 Signature: __________________________________________
  3. Date: ________________________________________________________
  1. Witness 2 Name: _______________________________________________
  2. Witness 2 Signature: __________________________________________
  3. Date: ________________________________________________________

This form must be made available to any healthcare personnel who may provide treatment to the patient. Please keep a copy with your important documents.

Document Features

Fact Name Fact Description
Definition The Florida Do Not Resuscitate (DNR) Order is a legal document that allows a person to decline resuscitation efforts in case of cardiac or respiratory arrest.
Governing Law Florida DNR Orders are governed by Florida Statutes, Chapter 401.45, which outlines the requirements and processes for establishing a DNR order.
Eligibility Only individuals aged 18 or older can complete a DNR order. It requires their signature, as well as the signature of a physician.
Implementation Healthcare providers must honor DNR orders, ensuring that they are properly documented in the patient’s medical records for enforcement in emergency situations.

How to Use Florida Do Not Resuscitate Order

Completing the Florida Do Not Resuscitate Order form is important for ensuring your healthcare preferences are honored. This form allows patients to clearly communicate their wishes about resuscitation. Follow these steps to fill out the form correctly.

  1. Obtain the Florida Do Not Resuscitate Order form. You can download it from the Florida Department of Health website or request a copy from your healthcare provider.
  2. Print the form. Ensure it is legible and free from any smudges or marks that could make it hard to read.
  3. Fill in your name and the date of birth in the designated spaces at the top of the form.
  4. Choose a qualified healthcare provider. You need to have a licensed physician fill out the medical section of the form. Schedule an appointment if necessary.
  5. Discuss your wishes with the physician. They will ask questions to understand your healthcare preferences clearly.
  6. Have the physician sign and date the form in the appropriate section. Their signature is essential for the form to be valid.
  7. Sign and date the form yourself, indicating that you understand its contents and agree to the terms.
  8. Make copies of the completed form. Keep one for your records and provide copies to your healthcare provider and family members.

Once you have filled out the form, make sure to discuss your wishes with your family and healthcare providers. This will help ensure everyone is informed and prepared to respect your decisions.

Your Questions, Answered

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

A Florida Do Not Resuscitate Order is a legal document that allows an individual to specify their wishes regarding resuscitation efforts in case of a medical emergency. It is particularly relevant for individuals with serious illnesses or conditions where they wish to prevent extraordinary life-saving measures. The DNR order instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) if the individual’s heart stops beating or if they stop breathing.

Who can create a DNR Order in Florida?

In Florida, any competent adult can create a DNR Order. This includes individuals who are at least 18 years old and are able to make informed decisions about their health care. Additionally, a legal representative, such as a healthcare surrogate or a guardian, may create a DNR Order for someone who is unable to do so due to incapacity. It is recommended that individuals discuss their wishes with family members and healthcare providers before formalizing the order.

How do I obtain a DNR Order form in Florida?

The Florida Department of Health provides a standardized DNR Order form that can be easily accessed online. Individuals can simply visit the Department of Health’s website and download the form. It is important to ensure that the form is filled out completely and signed by the patient and a licensed physician. Once completed, copies of the DNR Order should be kept in easily accessible places, such as with other important medical documents or on the refrigerator.

What should I do with the DNR Order once it is completed?

After completing the DNR Order, it is crucial to distribute copies to relevant parties. Here are some steps to take:

  1. Provide copies to your healthcare provider and ensure they have a copy in your medical records.
  2. Share copies with family members so they are aware of your wishes.
  3. Keep a copy readily accessible at home, such as on the refrigerator or near your bed.
  4. Consider providing copies to any assisted living facilities or hospitals you frequently visit.

Having these copies ensures that your wishes are communicated clearly during a medical emergency.

Can a DNR Order be revoked or changed?

Yes, a DNR Order can be revoked or changed at any time as long as the individual is still competent. To revoke the order, the person can simply destroy the document or clearly indicate their wish to revoke it in writing. It is essential to inform healthcare providers, family members, and anyone involved in the individual’s care about the changes to ensure that everyone is aware of the updated wishes. Regular discussions about one’s healthcare preferences are also encouraged to ensure that they reflect the current desires and circumstances.

Common mistakes

  1. Failing to understand the purpose of the Do Not Resuscitate (DNR) Order. This form is meant to communicate the patient’s wish not to undergo CPR or other resuscitation efforts in the event of cardiac arrest. Without a clear understanding, individuals may misinterpret the intent.

  2. Not filling out the form in its entirety. Incomplete forms can lead to misunderstandings and may not be honored by medical professionals. It’s crucial to provide all requested information, such as the patient’s name, date of birth, and signature of the physician.

  3. Using outdated versions of the form. Regulations and forms can change over time. Ensure that you are using the most current version of the Florida DNR Order form to avoid complications.

  4. Neglecting to review the form with a healthcare provider. Consulting with a doctor can help clarify any confusing aspects of the form, ensuring it aligns with the patient's medical needs and wishes.

  5. Not signing or dating the form. A DNR Order must be signed and dated by a qualified physician to be valid. An unsigned or undated form can lead to enforcement issues during emergencies.

  6. Failing to communicate the DNR status clearly. Once the DNR Order is filled out, it’s essential to inform family members, caregivers, and medical staff. Clear communication helps prevent potential disputes or confusion in critical situations.

  7. Assuming the DNR Order applies across state lines. While Florida honors its own DNR form, other states may have different requirements. If you travel, ensure that you have the appropriate documents for those locations.

  8. Not revisiting the DNR Order regularly. Life circumstances change, and so may a person’s healthcare preferences. Regularly reviewing and updating the DNR form ensures it reflects current wishes.

  9. Believing that a DNR Order means a lack of medical care. This is a common misconception. A DNR Order only applies to resuscitation efforts in the event of cardiac arrest and does not mean that other forms of medical treatment will be denied.

Documents used along the form

In addition to the Florida Do Not Resuscitate (DNRO) Order form, various documents and forms often accompany it to ensure comprehensive communication of a person's healthcare preferences. Here are some key documents that may be relevant.

  • Advance Directive: This is a broad legal document outlining a person's wishes regarding medical treatment if they become unable to express those wishes. It often includes a living will and designates a healthcare surrogate.
  • Living Will: A specific type of advance directive that details the types of medical treatment a person wants or does not want at the end of life. It provides guidance about life-sustaining measures.
  • Healthcare Proxy: This document appoints someone to make medical decisions on behalf of an individual when they are not able to do so themselves, ensuring that healthcare preferences are honored.
  • Physician Orders for Life-Sustaining Treatment (POLST): A medical order that communicates patients' wishes regarding treatment in emergency situations. POLST is designed for individuals with serious illnesses.
  • Palliative Care Plan: This document outlines goals for relief from the symptoms and stress of a serious illness. It emphasizes comfort and quality of life rather than curative treatment.
  • Do Not Intubate (DNI) Order: This is a medical order indicating that a patient should not receive endotracheal intubation. It is often used in conjunction with DNRO in specific situations.
  • Medication Management Form: This form details the medications a patient is taking, including those they wish to discontinue. It helps healthcare providers align treatment with a patient’s goals.
  • Emergency Medical Services (EMS) Notification: Some individuals choose to notify local EMS providers about their DNRO status. This can expedite the adherence to their wishes during emergencies.

Each of these documents serves a distinct purpose and helps ensure that an individual's healthcare preferences are respected. It is advisable to consult with a healthcare professional or legal advisor when preparing these forms to ensure they are properly completed and truly reflect one's wishes.

Similar forms

The Living Will is a document that outlines an individual’s preferences regarding medical treatment in circumstances where they can no longer voice their wishes. Like the Florida Do Not Resuscitate Order (DNRO), it focuses on end-of-life decisions. Both documents help ensure that a person’s healthcare choices are respected, alleviating potential burdens on family members and healthcare providers. They offer peace of mind by making explicit a person's desires about life-sustaining treatments and interventions.

A Healthcare Surrogate Designation allows an individual to name a person who will make medical decisions on their behalf if they become incapacitated. Similar to the DNRO, which explicitly states what should not be done in emergencies, this document is about control over future medical decisions. It ensures that someone the individual trusts will uphold their values and wishes, creating a framework for care during critical times.

The Advanced Healthcare Directive combines elements of both the Living Will and Healthcare Surrogate Designation. This comprehensive document provides a way to articulate medical treatment preferences and appoint someone to make decisions. Like the DNRO, it serves to express specific healthcare wishes, ensuring they are honored even when the person cannot communicate them directly.

The Physician Orders for Life-Sustaining Treatment (POLST) is another important document. It provides specific medical orders and is intended for individuals with serious health conditions. While the DNRO explicitly states a wish for no resuscitation, the POLST form includes a range of treatments and preferences. Both aim to provide clarity about a patient’s wishes to emergency healthcare personnel, allowing for more effective and respectful care.

The Medical Power of Attorney (MPOA) is a legal document that appoints someone to make healthcare decisions on a person's behalf. While the DNRO is focused solely on resuscitation preferences, the MPOA can cover a wider scope of medical decisions, including those outlined in a living will. Both documents are vital for ensuring that an individual’s healthcare preferences are communicated and respected while they are unable to speak for themselves.

Do Not Intubate Orders are similar in purpose to a DNRO but focus specifically on the wish to avoid intubation in the event of respiratory failure. This order serves a narrow niche, like the DNRO, in preventing unwanted medical interventions. Both documents prioritize the patient’s comfort and dignity by specifying what should not happen in emergent situations.

A DNR bracelet or necklace serves as a portable identification for individuals with a Do Not Resuscitate Order. It directly communicates the person’s wishes to first responders, similar to how the written DNRO document is intended to function. Visibility of such a bracelet in an emergency enhances the likelihood that healthcare providers will respect the individual’s stated desires during critical moments.

Finally, Hospice Care Agreements share similarities with the DNRO in that both are utilized for patients facing terminal illnesses. The agreement outlines the type of care a patient wishes to receive as they approach the end of life, putting emphasis on comfort and family support. Like the DNRO, these agreements are essential for clarifying patient preferences to avoid unwanted resuscitation efforts and ensure that the patient’s values are respected during their final days.

Dos and Don'ts

Filling out the Florida Do Not Resuscitate Order form requires careful consideration. Here are some important dos and don'ts to remember:

  • Do discuss your decision with your healthcare provider.
  • Do make sure your form is completed in accordance with Florida law.
  • Do keep a copy of the signed form in an accessible place.
  • Do inform your family and loved ones about your wishes.
  • Do review the form regularly to ensure it reflects your current wishes.
  • Don't sign the form without fully understanding its implications.
  • Don't rely solely on verbal communication of your wishes.
  • Don't forget to check that all required signatures are present.
  • Don't think your decision is permanent without the option to review it later.

Misconceptions

Many people hold misconceptions about the Florida Do Not Resuscitate Order (DNRO) form. Understanding the truth behind these myths is vital for making informed decisions about healthcare options. Below are five common misconceptions along with explanations to clarify them.

  • Misconception 1: A DNRO means a patient is giving up on life.
  • This is perhaps the most significant misunderstanding. Opting for a DNRO does not mean a person desires to end their life. Instead, it reflects a decision to not undergo cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest. Many people choose this route to avoid invasive medical procedures if they are terminally ill or wish to die naturally.

  • Misconception 2: A DNRO is only for elderly patients.
  • This misconception limits the applicability of the DNRO. Any individual, regardless of age, can request a DNRO if they are facing a serious medical condition or have a clear understanding of their health status. It’s a personal decision that should align with one’s values and wishes.

  • Misconception 3: A DNRO is effective in all healthcare settings.
  • This is not necessarily true. The DNRO is specifically designed for situations involving emergency medical services (EMS) and hospitals. Some healthcare environments may require a different approach or documentation, so it's essential to verify that your wishes are honored across all types of care settings.

  • Misconception 4: A DNRO automatically includes a refusal of other medical treatments.
  • A DNRO solely addresses CPR. It does not imply that a person is refusing other medical interventions, such as medications or surgeries. Individuals can choose a DNRO while still accepting treatments that align with their health goals and preferences.

  • Misconception 5: A DNRO cannot be revoked.
  • This is incorrect. A DNRO can be revoked or updated at any time. If circumstances change or an individual decides they wish to receive CPR, they can simply destroy the DNRO form and inform their healthcare providers of their new choice.

Key takeaways

When it comes to filling out and utilizing the Florida Do Not Resuscitate Order (DNRO) form, there are some essential points to keep in mind. These takeaways can help ensure that your wishes are clearly understood and respected.

  • Clarity of Intent: Be explicit about your wishes regarding resuscitation. The DNRO form should clearly indicate your preference not to receive cardiopulmonary resuscitation (CPR) in case of a medical emergency.
  • Authorized Signatures: Ensure that the form is signed by both the patient and a physician. This signature confirms that the patient has made an informed decision regarding their care.
  • Placement and Accessibility: Keep the DNRO form in an easily accessible location. It’s advisable to display it prominently, such as on the refrigerator or medical file, so that first responders can quickly find and act according to your wishes.
  • Regular Updates: Review and update the DNRO as necessary. Life circumstances and medical conditions can change, so it’s crucial to ensure that the document reflects your current desires.

Following these guidelines can help relieve some of the stress that may come with end-of-life decisions. Make sure your healthcare providers and family are informed about your choices.

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