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The Florida Do Not Resuscitate Order (DNRO) form plays a crucial role in medical decision-making for individuals who wish to express their preferences regarding resuscitation efforts in the event of a life-threatening emergency. This legally recognized document allows patients to refuse cardiopulmonary resuscitation (CPR) and other life-saving measures if their heart stops beating or if they stop breathing. It is important for individuals to understand that the DNRO form must be completed and signed by a qualified physician, ensuring that the patient's wishes are documented and respected by healthcare providers. Once executed, the form must be easily accessible, as it should accompany the patient during medical emergencies. Additionally, the DNRO form is distinct from other advance directives, such as living wills, as it specifically addresses resuscitation efforts. Understanding the implications of this form can empower individuals to make informed choices about their end-of-life care, providing peace of mind for both patients and their families.
Form Example
Florida Do Not Resuscitate Order (DNR) Template
This document serves as a Do Not Resuscitate Order (DNR) pursuant to the Florida Statutes relating to "Do Not Resuscitate Orders." It is a legally binding document that indicates an individual's wish not to receive cardiopulmonary resuscitation (CPR) in the event that their breathing stops or their heart stops beating. Please complete all sections to ensure the order meets legal requirements and accurately reflects the wishes of the individual it concerns.
Part 1: Patient Information
- Patient's Full Name: _______________________________
- Date of Birth (MM/DD/YYYY): _________________________
- Address: __________________________________________
- City: ___________________ State: FL Zip Code: _________
- Primary Contact Name: ______________________________
- Relationship to Patient: ____________________________
- Contact Number: ___________________________________
Part 2: Do Not Resuscitate Order Declaration
I, ___________________________________ [Patient's Name], hereby declare that I do not wish to receive cardiopulmonary resuscitation (CPR) in the event that my breathing stops or my heart stops beating. This decision is made after careful consideration of the medical implications and with a full understanding of my right to accept or refuse medical treatment. It is my wish that this order be followed by all medical personnel, including emergency medical services, in accordance with Florida laws governing Do Not Resuscitate Orders.
Part 3: Physician Information and Signature
- Physician's Full Name: ______________________________
- License Number: ____________________________________
- Address: ___________________________________________
- City: ___________________ State: FL Zip Code: _________
- Phone Number: ______________________________________
- Signature: _________________________________________
- Date: ______________________________________________
Part 4: Witness Statement
As witness to the signing of this document by the patient and understanding the patient's wishes regarding Do Not Resuscitate Orders, I hereby affirm that the patient appears to be of sound mind and under no duress, menace, fraud, or undue influence at the time of this declaration.
- Witness 1 Full Name: ________________________________
- Signature: __________________________________________
- Date: _______________________________________________
- Witness 2 Full Name: ________________________________
- Signature: __________________________________________
- Date: _______________________________________________
This Do Not Resuscitate Order is made voluntarily by me and reflects my wishes. It is understood that this order does not affect the provision of other types of medical care, including treatments for pain relief, and other care necessary for my comfort or to alleviate my suffering.
Notice: This document is legally binding throughout the State of Florida. A copy of this document should be provided to your physician, local hospital, and family members. It can be revoked at any time by the patient through a written or oral statement to their healthcare provider.
Form Specifications
| Fact Name | Description |
|---|---|
| Purpose | The Florida Do Not Resuscitate Order (DNRO) form allows individuals to refuse resuscitation efforts in the event of cardiac or respiratory arrest. |
| Governing Law | The DNRO is governed by Florida Statutes, specifically Section 401.45, which outlines the legal framework for advance directives and medical orders. |
| Eligibility | Any adult who is capable of making informed healthcare decisions can complete a DNRO form. This includes individuals with terminal conditions or severe illnesses. |
| Signature Requirements | The form must be signed by the individual and witnessed by two adults or signed by a healthcare surrogate, ensuring that it reflects the individual's wishes. |
| Validity | A completed DNRO form remains valid as long as it is properly executed and the individual is alive. It can be revoked at any time by the individual. |
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