Florida Do Not Resuscitate Order (DNR) Form

The Florida DNR form is a document that is filled out by such parties as patient and physician in cases when the former does not want to be resuscitated. People who have incurable illnesses use this form to announce that physicians should not resuscitate them when they have a heart or respiratory attack. The most common reason for filling out the Do Not Resuscitate Form is a terminal state of the patient or a chain of chronic diseases when any reviving procedures will only destroy the brain.

The crucial thing is that all medical staff should follow the rules prescribed by the DNR form even if they consider it inappropriate. As for physicians, they can declare that the completion of the DNR form by a patient is an incorrect decision and transfer responsibilities to another doctor.

Florida DNR Form Laws and Requirements

If a patient cannot sign the form, their representatives can do it if they are guardians of the person or have a right to act on their behalf. This situation is common as terminally ill patients are often not able to make any decisions consciously.

One of these three conditions should be met to make friend or relative of the patient responsible for this decision:

  • Terminal state of a patient
  • The patient is permanently unconscious
  • Resuscitation operations will worsen the state of a patient

The form can be accepted as valid only if the patient and physician signed it by hand and it is printed on yellow paper. You can find more requirements and restrictions related to wording or filling out the process of the Florida DNR form in rule 64J-2.018 of the Florida Administrative Code.

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Download your fillable Florida DNR form in PDF format.

How to Fill Out Florida DNR Form

The Florida DNR form completion process does not require additional knowledge, and you can make it by yourself.

Follow the guide below to ensure the correctness of entered info and the structure of the form.

  • Enter the Full Name of the Patient

The first line of the form requires you to enter the full patient’s name according to one printed in legal IDs.

step 1 to filling out the florida dnr form - enter the full name of the patient

  • Fill in the Date of Form Completion

Write the date of document signing in the second part of the first line of the form.

step 2 to filling out the florida dnr form - fill in the date of form completion

  • Choose a Person Who Signs the Form

As we said above, there are cases when relatives or friends of a patient can decide on the refusal of resuscitation on behalf of the patient. If the patient cannot sign the form, you have to clarify it in the DNR form. Choose a proper checkbox among the four options based on the relation of the signing person to the patient.

step 3 to filling out the florida dnr form - choose a person who signs the form

  • Sign the Document

The person who fills out the form should sign it and write their full name. It can be the patient or a representative of a diseased person if there are documents that can prove the legality of the representative’s actions on behalf of the patient.

step 4 to filling out the florida dnr form - sign the document

  • Enter Information About a Physician

A physician should complete the next part of the form by filling in their data. If the physician agrees to follow the rules prescribed by the DNR form about the patient, they must provide a full name, contact number, and medical license number. Moreover, the physician must sign the form and write the date of the signing process.

step 5 to filling out the florida dnr form - enter information about a physician

  • Fill in the Portable Part of the Form

As all the medical staff should know patients’ intentions about resuscitation procedures, a portable part of the form must be attached to the patient. That is why patients or representatives and physicians have to fill in the same information they entered before to portable forms. For a patient or representative, it should include the full name of the patient, date of signing, the role of the representative person, signature, and full name of the signee. As for the physician, they should enter the full name, emergency phone number, number of medical license, signature, and date.

step 6 to filling out the florida dnr form - fill in the portable part of the form

If the patient and physician fill out all the fields of the Florida DNR correctly, the form will be perceived as valid, and all the medical workers will need to follow the requirements of the law.

Published: Oct 18, 2021