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Florida Do Not Resuscitate Order
This Do Not Resuscitate (DNR) Order is created in accordance with Florida Statutes, particularly Section 401.45, allowing patients to express their wishes regarding resuscitation efforts in the event of a medical emergency.
Patient Information:
- Name: _________________________________
- Date of Birth: _________________________
- Address: ________________________________
- Phone Number: _________________________
Healthcare Proxy (if applicable):
- Name: _________________________________
- Relationship: ___________________________
- Phone Number: _________________________
With this DNR Order, I, the undersigned, wish to convey the following:
- I do not wish to receive cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest.
- I understand that this order will be honored by all medical personnel and healthcare providers.
- I am aware of the consequences of not receiving resuscitation efforts.
Signature of Patient: _________________________
Date: ________________________________________
Signature of Witness: _________________________
Date: ________________________________________
This DNR Order should be placed in a visible location and shared with healthcare providers, family members, and anyone involved in the patient’s care.
If you have questions about this order, it is recommended to consult with a healthcare professional or legal expert.
Form Data
| Fact Name | Description |
|---|---|
| Definition | The Florida Do Not Resuscitate (DNR) Order is a legal document that allows a person to refuse resuscitation efforts in the event of cardiac arrest. |
| Governing Law | This order is governed by Florida Statutes, specifically Section 401.45, which outlines the requirements and validity of DNR orders. |
| Eligibility | Any adult or legally authorized representative can complete a DNR order, provided they are of sound mind and understand the implications of the decision. |
| Required Signatures | A valid DNR order must be signed by the patient or their representative and a physician, ensuring that the decision is informed and voluntary. |
| Revocation | The DNR order can be revoked at any time by the patient or their representative, either verbally or by destroying the document. |
Florida Do Not Resuscitate Order - Usage Guidelines
Completing the Florida Do Not Resuscitate Order form is an important step in ensuring your healthcare preferences are respected. This document allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. Follow the steps below to accurately fill out the form.
- Obtain the Florida Do Not Resuscitate Order form. This can be found online or requested from a healthcare provider.
- Begin by entering your full name in the designated space at the top of the form.
- Provide your date of birth. This helps to confirm your identity.
- Fill in your address, including city, state, and zip code.
- Indicate your phone number for any necessary follow-up or clarification.
- Next, you will need to select a healthcare surrogate, if applicable. This person will be responsible for making decisions on your behalf if you are unable to do so.
- Sign and date the form. Your signature is essential to validate your wishes.
- Have your signature witnessed by two individuals who are not related to you and who do not stand to benefit from your estate.
- Make copies of the completed form for your records and share copies with your healthcare provider and surrogate.
Once you have filled out the form and ensured all information is accurate, it is important to discuss your decisions with your healthcare provider and loved ones. This helps to ensure that everyone understands your wishes and can advocate for you if necessary.
Some Other Do Not Resuscitate Order State Templates
Dnr Form Pennsylvania - Fosters respect for personal autonomy in healthcare settings.
A Colorado Medical Power of Attorney form is a vital legal document that empowers an individual to appoint someone else to make critical medical decisions on their behalf if they become incapacitated. This important tool ensures that a person's healthcare preferences are honored, even when they cannot communicate them. To learn more about how to effectively complete this form, visit Colorado PDF Templates, which provides valuable resources and guidance for safeguarding medical choices.
Dnr Rules and Regulations - A document that needs to be easily accessible for healthcare providers in emergencies.
Can You Have a Dnr at Any Age - A DNR order does not limit the medical care patients can receive; it strictly pertains to resuscitation efforts.
Dos and Don'ts
When completing the Florida Do Not Resuscitate Order form, it is important to approach the process with care and consideration. Here is a list of things you should and shouldn't do to ensure that your wishes are clearly communicated.
- Do consult with your healthcare provider to understand the implications of the order.
- Do ensure that the form is filled out completely and accurately.
- Do sign and date the form to validate your request.
- Do discuss your decision with family members to avoid confusion later.
- Do keep a copy of the completed form in an easily accessible location.
- Don't use the form if you are not certain about your wishes regarding resuscitation.
- Don't forget to review and update the form if your health situation changes.
- Don't assume that verbal instructions will be honored without the written form.
- Don't neglect to inform your healthcare team that the order exists.
By following these guidelines, you can help ensure that your preferences regarding resuscitation are respected and understood. Making informed decisions is a crucial part of healthcare planning.
Common mistakes
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Not understanding the purpose of the form. Many people fill out the Florida Do Not Resuscitate Order (DNRO) without fully grasping its implications. It’s essential to know that this form specifically instructs medical personnel not to perform CPR if your heart stops or you stop breathing. It does not affect other medical treatments.
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Failing to discuss with family or healthcare providers. Before completing the DNRO, it’s crucial to have open conversations with family members and healthcare professionals. This ensures everyone understands your wishes and can support your decisions, reducing confusion during critical moments.
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Not signing the form correctly. The DNRO must be signed by the person making the request or their legal representative. If the form is not signed correctly, it may be deemed invalid. Always double-check that the signatures are clear and in the right places.
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Neglecting to date the form. An often overlooked detail is the date on the DNRO. Without a date, medical personnel may question the form's validity. It’s vital to include the date to ensure that your wishes are clear and current.
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Not keeping copies accessible. After completing the DNRO, it’s important to keep copies in accessible locations. Family members, healthcare providers, and emergency contacts should have a copy. If the form is not readily available, it may not be honored in an emergency.