Updated:
A Florida DNR form is a written do not resuscitate order. It directs medical staff to withhold cardiopulmonary resuscitation (CPR) if a patient's heart or breathing stops. People with a terminal illness or a serious chronic condition often use one. The patient's physician or physician assistant must sign it, along with the patient or, if the patient is incapacitated, the patient's representative.[1.1] It is not a living will or a power of attorney. Download the Florida do not resuscitate form below as a PDF.
Build Your Document
Answer a few simple questions to make your document in minutes
Save and Print
Save progress and finish on any device, download and print anytime
Sign and Use
Your valid, lawyer-approved document is ready
The Florida do not resuscitate laws for a DNR order are in Section 401.45 of the Fla. Stat. The order must be on the form adopted by rule of the department.[1.2] The patient's physician or physician assistant must sign it, and so must the patient or the patient's representative.[1.1]
| Requirement | What the statute says |
|---|---|
| The adopted form | An order not to resuscitate, to be valid, must be on the form adopted by rule of the department.[1.2] |
| Physician signature | The form must be signed by the patient's physician or physician assistant.[1.1] |
| Patient signature | The patient signs. If the patient is incapacitated, a health care surrogate or proxy, a court-appointed guardian, or an attorney in fact under a durable power of attorney signs instead.[1.1] |
An incapacitated patient's signature comes from one of these people:
The form must be signed by the patient's physician or physician assistant and by the patient or, if the patient is incapacitated, the patient's health care surrogate or proxy as provided in chapter 765, court-appointed guardian as provided in chapter 744, or attorney in fact under a durable power of attorney as provided in chapter 709.
The Patient's Statement on the form has a check box for each of these roles. Check the box that matches the person who signs. Leave all the boxes empty when the patient signs.
The department's form is DH Form 1896, Do Not Resuscitate Order (02/2024), which Fla. Admin. Code R. 64J-2.018 incorporates by reference.[2.1]
The same rule sets how emergency crews treat the order. An EMT or paramedic must withhold or withdraw CPR when shown an original or a copy of the DNRO or of the DNRO Device, the reduced-size wallet card version of the order. This includes a previous version of the form.[2.1] The original is the completed order on yellow paper with the handwritten signatures, and any shade of yellow is acceptable. An EMT or paramedic is not required to withhold CPR if the original or copy of the order is not on yellow paper, its content is altered from the original, or any printed wording on it is not legible.[2.1]
The Florida DNR form is a short order with a patient section and a physician section. A portable copy repeats the same entries. The form asks for the patient's full legal name, the date, a statement that CPR be withheld or withdrawn, and signatures from both sides.
Two people fill out the Florida DNR form: the patient, or the person who signs for the patient, and the patient's physician. Use ink, as the form asks. Work through these parts in order, then fill in the portable copy with the same details.
Patient's full legal name. Print or type the patient's full legal name on the first line. Use the name shown on the patient's photo ID.
Date. Write the date at the right end of the same line.
Patient's Statement boxes. If the patient signs, leave the boxes empty. If someone else signs, check the box for that person's role: Surrogate, Proxy, Court appointed guardian, or Durable power of attorney.
Applicable Signature. The person named in the Patient's Statement signs on the Applicable Signature line. That person then prints or types their name beside the signature.
Physician's Statement. The physician signs, writes the date, adds an emergency telephone number, then prints or types their name and medical license number. The statement is worded for a physician licensed under Chapter 458 or 459, F.S.
Portable copy. Repeat the patient and physician entries on the portable copy, so the patient has a copy with the same details.
Many people give copies of the signed order to family members, caregivers, and other health care providers and keep the original with their other health care documents, where it is easy to find. A DNR order is separate from a living will. You can type the entries into the downloaded PDF with the PDF editor before you print the document. Looking for another state? Browse the DNR forms by state.
The patient's physician or physician assistant signs the order. The patient signs too. If the patient is incapacitated, the patient's health care surrogate or proxy, a court-appointed guardian, or an attorney in fact under a durable power of attorney signs for the patient.[1.1]
To be valid, an order not to resuscitate must be on the form adopted by rule of the department.[1.2] The form must also carry the signatures of the patient's physician or physician assistant and of the patient or the patient's representative.[1.1]
A DNR order must be on the form adopted by rule of the department.[1.2] It needs the signature of the patient's physician or physician assistant. It also needs the signature of the patient or, if the patient is incapacitated, the patient's representative.[1.1]
General information, not legal or tax advice.
