Do Not Resuscitate Order
|
|||
DNRO Form and Information for Download |
Do
Not Resuscitate Order - Form 1896 (Multilingual) Important! In order to be legally valid this
form MUST be printed on yellow
legal paper prior to being completed. EMS and medical personnel are only required to honor the form if it is printed on
yellow legal paper. |
A Do Not Resuscitate Order (DNRO) is a form or patient
identification device developed by the Department of Health to identify
people who do not wish to be resuscitated in the event of respiratory or
cardiac arrest. A copy of the form can be obtained by downloading
the form from this site (on yellow
legal paper only). You may also contact the Department of Health
directly to request the form by calling our toll-free number
800-226-1911, extension 2780, or 850-245-4440 extension 2780.
What is a Do Not Resuscitate Order?
A Do Not Resuscitate Order ( Form 1896) is a form developed by the Department of Health to identify people who do not wish to be resuscitated in the event of respiratory or cardiac arrest.
Go to top ↑
Who should have a Do Not Resuscitate Order?
Do Not Resuscitate Order forms are generally used by someone who is suffering from a terminal condition, end-stage condition or is in a persistent vegetative state. If you are not sure if a DNRO would be appropriate for you, or you would like additional information, it is best to consult your physician as well as an attorney.
Go to top ↑
What is the difference between a living will and a DNRO?
A DNRO deals specifically with the refusal of cardiopulmonary resuscitation in the event of cardiac or pulmonary arrest. It is a physician's order, signed and dated. Living wills, or any advanced directive, deal with a broader spectrum of end of life related issues. For information on living wills or advance directives please contact the Department of Elder Affairs helpline at (850) 414-2000.
Go to top ↑
For information on living wills or advance directives, please contact the Department of Elder Affairs helpline at (850) 414-2000.
Go to top ↑
Why should an individual complete a do not resuscitate order if he or she already has a living will?
A living will is a document that instructs, as specifically as possible, what care and treatment the person wishes under certain circumstances. Any competent person can fill out a living will at any time. A DNRO is a physician’s order to withhold or withdraw resuscitation if a patient goes into cardiac or pulmonary arrest. It is part of the prescribed medical treatment plan and must have a physician’s signature. It is usually written for patients who are terminally ill, suffering from an end-stage condition or who are in a persistent vegetative state.
Go to top ↑
In what health care settings are the DNRO form honored?
Pursuant to Florida law, the DNRO is honored in most health care settings, including hospices, adult family care homes, assisted living facilities, emergency departments, nursing homes, home health agencies and in hospitals. Florida law further provides that health care providers employed in these health care settings may withhold or withdraw cardiopulmonary resuscitation if presented with a DNRO and be immune from criminal prosecution or civil liability. In addition, when the DNRO is presented to an emergency medical technician or paramedic in a setting other than a health care facility, the form may be honored. Please refer to the links above for a definition of a cardiopulmonary resuscitation. Facilities may honor the form, but they may also honor their own internal forms. Please consult with your risk management/legal office concerning the use of the form in specific health care settings.
Go to top ↑
How will the properly completed DNRO form look?
The properly completed form will be signed by the competent patient, or the patient’s representative, signed by a Florida licensed physician, and it will be on either the original canary yellow form or copied onto similar colored paper.
Go to top ↑
Can I print it on white paper?
No. Florida Administrative Code 64J-2.018 states specifically that the form shall be printed on yellow legal paper. The form is not valid unless it is printed on some shade of yellow legal paper. EMS providers and hospitals are not obligated to honor a form printed on white paper or any other color than yellow.
Does it have to be notarized or witnessed?
No, the form is simply signed by the patient, healthcare surrogate or healthcare proxy and the patient's physician. This is a physician's order.
Go to top ↑
The DNRO form should be kept in a noticeable, easily accessible place such as the head or foot of a bed, or on the refrigerator. It should be readily available in the event of an emergency to ensure that the patient’s last wishes will be honored.
Go to top ↑
Is it a requirement to post it somewhere in particular?
No. The Florida Administrative Code does not specifically list a place to keep the form. We do recommend it be somewhere familiar and easily accessible at all times of the day and night. Many people keep the forms on a refrigerator or on the wall by their bed or bedroom door, as many EMS providers are instructed to look for information on medications (Vial of Life Program) in these places.
Go to top ↑
Is the form good outside of Florida? Can I use a form from another state?
No. This form only applies to those in Florida. Even if someone is planning on visiting family in the state or is living in Florida temporarily, a form outside of Florida will not be accepted. For this reason we do suggest they fill out a Florida DNRO form for the duration of the stay in the state.
Go to top ↑
The form can be revoked at any time either orally or in writing, by physical destruction, by failure to present it, or by orally expressing a contrary intent by the patient or the patient’s health care surrogate.
Go to top ↑
Can a family member revoke the form?
If they signed the DNRO form as the health care surrogate or health care proxy they can revoke the form in writing, by physical destruction, failure to present the form, or orally expressing a contrary intent. The patient can revoke the form in the same manner if they were the one to sign the form. Only those that signed the form (patient, healthcare surrogate or healthcare proxy) may revoke the form, 64J-2.018, FAC.
Go to top ↑
What is a patient identification device?
Attached to the bottom of the Department of Health’s Form 1896 is a patient identification device, which may be removed from the form, laminated and can be worn on a chain around the neck, clipped to a key chain or to clothing/ bed, etc. so it can travel with the patient. It is equally as valid as the DNRO form and can be presented to emergency medical services when they arrive on scene and is designed to allow the patient to move between settings with one document.
Go to top ↑
Does the patient identification device need to be completed for the form to be valid?
No, the patient identification device is an added option to the form to allow for portability and convenience. It does not have to be completed unless the person wishes to remove it and carry it between settings. Copies of the form on yellow legal paper will serve the same purpose.
Go to top ↑
Should 9-1-1 still be called if the patient has a do-not-resuscitate order?
9-1-1 can be called at any time to provide family/caregivers with back up and support for the patient. Many family members call 9-1-1 to control pain and to make sure the patient is comfortable. Others may want the patient to be transported to the hospital so the attending physician will be present. Emergency medical services are part of the community and are able to provide appropriate care as needed in many capacities. A DNRO only means that in the event of cardiac or pulmonary arrest that CPR will not be initiated. Comfort care measures, such as oxygen administration, hemorrhage control and pain management, will still be used.
Go to top ↑
Where can the do not resuscitate form be obtained?
Download the Do Not Resuscitate Order - Form 1896
SPECIAL NOTICE - PLEASE READ:
Per Florida Administrative Code 64J-2.018
this form MUST be printed on
yellow legal stock paper
to be a legally-recognized form!The form can also be obtained for free by writing to:
The Florida Department of Health
Division of Emergency Preparedness and Community Support
Trauma Program
4052 Bald Cypress Way, Bin C-18
Tallahassee, FL 32399-1738
You may also call the Department of Health to request a form at (850) 245-4440 extension 2780.
Additional information on advance directives and end-of-life care can be obtained through the Agency for Health Care Administration and the Department of Elder Affairs, nursing homes, assisted living facilities, senior centers, physicians and local attorneys.
Go to top ↑
Yes, but you must have legal size yellow legal paper in the fax machine or copy the faxed form onto yellow legal paper upon receipt in order for it to be valid. Some fax machines do not print clear faxes and since the form must be completely legible to be a legally recognized form, it may be best to order forms from DOH or download the form off of our website.
Go to top ↑
Is there a charge for the form?
No, the Department provides the form at no cost no matter the quantity. We do encourage that the facilities make copies once they receive enough originals to get them started.
Go to top ↑
Is it permissible to copy the DNRO form?
The form may be copied either onto similarly colored yellow legal paper either blank or after it has been correctly filled out and signed. Copies of the form are also required by Florida Administrative Code to be honored by EMS personnel, as long as they are on similarly colored yellow legal paper and are completely legible.
Go to top ↑
No. The form does not expire. Past versions of the forms will also be honored. If the Department of Health approves an updated version, consumers do not need to fill out the updated version per 64J-2.018(2)(a), FAC.
Go to top ↑
Chapter 765 , Florida Statutes address end-of-life issues. Chapter 64J-2.018, Florida Administrative Code (pdf 187.15kb/20 pages) addresses the Do Not Resuscitate Order and can be located by using the link above.
Go to top ↑
Florida residents can also call
the
Florida Legislative Division
Toll-free: 1-800-342-1827