Florida Do Not Resuscitate Order
This Do Not Resuscitate (DNR) Order is made in accordance with Florida State Law. It is a legal document indicating that medical personnel should not perform cardiopulmonary resuscitation (CPR) if the patient stops breathing or their heart stops beating.
Please complete the following sections to ensure your wishes are clearly documented. It is essential to have this form signed in front of a witness to be considered valid.
Patient Information:
- Name: _______________________________
- Date of Birth: ________________________
- Address: _____________________________
- Phone Number: ________________________
Healthcare Advocate Information:
- Full Name: ____________________________
- Relationship to Patient: _______________
- Contact Number: _______________________
Signatures:
By signing below, you affirm that you understand the contents of this DNR Order and that it reflects your wishes regarding resuscitation:
- Patient Signature: _____________________
- Date: ________________________________
- Witness Signature: ____________________
- Date: ________________________________
This document should be kept in an accessible location and provided to your healthcare providers. Review this order periodically to ensure it still reflects your wishes. Your health and peace of mind are of the utmost importance.