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Florida Do Not Resuscitate (DNR) Order Form

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The Florida do not resuscitate order form (DNR or DNRO) is a document that is used by citizens of the State who suffer from incurable or irreversible medical conditions. This form states that the requester does not wish to be resuscitated in the event of respiratory or cardiac arrest. Although not always reserved for patients with terminal illnesses, it is the most common reason for a physician to sign off on a DNR order. A DNR must be honored in any health care setting by all medical personnel, including EMTs and paramedics outside of a medical facility. For a Florida DNR to be legally valid, the form must be printed on yellow paper before it is filled out by the patient/authorized representative and physician.

LawsFAC 64J-2.018

Required to Sign – Patient and physician.

How to Write

Step 1 – Download the Florida DNRO in Adobe PDF. Print this form on yellow paper – do not complete the form before it has been printed on yellow paper. 

Step 2 – Enter the patient’s full name and the current date at the top of the form.

Step 3 – To confirm that the patient wishes to avoid CPR should the situation arise, they must sign and print their name on the appropriate field. If the patient’s decisions are being made by an authorized representative, they must select the applicable checkbox, and sign and print their name.

Step 4 – In the ‘Physician’s Statement’ section, the physician must sign their name on the appropriate line. They must also include the date, their phone number, their printed name and their medical license number.

Step 5 – The section of the page below the dotted line, once completed, can be separated from the form and kept on the patient’s person. This is an added option and need only be used if the patient wishes to carry it with them. For this part of the form to be valid, both the physician and patient (or representative) should enter the same information as on the main part of the form.