FLORIDA DO NOT RESUSCITATE ORDER (DNRO)
(Prepared for compliance with Fla. Stat. § 401.45(3) and current Florida Department of Health EMS protocols)
[// GUIDANCE: This template combines statutory DNRO requirements with enhanced contractual‐style protections requested by the client. Practitioners may pare back sections III-IX to align with customary medical-directive brevity while preserving the essential order language mandated by Florida law.]
TABLE OF CONTENTS
I. Document Header
II. Definitions
III. Operative Provisions
IV. Representations & Warranties
V. Covenants & Restrictions
VI. Default & Remedies
VII. Risk Allocation
VIII. Dispute Resolution
IX. General Provisions
X. Execution Block
I. DOCUMENT HEADER
1. Title & Form Identification
This instrument is a “Florida Do Not Resuscitate Order” (“DNRO”) conforming to § 401.45(3), Florida Statutes, and the requirements of Florida Department of Health Form DH 1896.
2. Parties
a. Patient: [PATIENT LEGAL NAME], (“Patient”).
b. Authorized Health Care Decision-Maker (if any): [SURROGATE/PROXY NAME] (“Surrogate”).
c. Attending Physician: [PHYSICIAN NAME], M.D./D.O., Florida License No. [NUMBER] (“Physician”).
d. Health-Care Providers & EMS Personnel: Collectively, all licensed individuals or entities who may render emergency medical care to Patient (“Providers”).
3. Recitals
A. Patient has the legal capacity, or is represented by a duly authorized Surrogate, to make end-of-life decisions.
B. Patient desires that no cardiopulmonary resuscitation (“CPR”) be attempted in the event of cardiac or pulmonary arrest.
C. Physician, after appropriate consultation, concurs with Patient’s decision and hereby issues a medical order to that effect.
D. Providers require a compliant DNRO to honor the decision and obtain statutory immunity when acting in good faith.
4. Effective Date & Governing Law
This DNRO is effective upon the latest signature date in Section X and is governed exclusively by the laws of the State of Florida.
II. DEFINITIONS
- “Advance Directive” – Any written instruction recognized under Ch. 765, Fla. Stat., relating to Patient’s health-care decisions.
- “Cardiopulmonary Resuscitation” or “CPR” – Chest compressions, defibrillation, advanced airway management, artificial ventilation, or the administration of resuscitative drugs to restore cardiac or respiratory function.
- “DNRO” – This Do Not Resuscitate Order, executed on Florida Department of Health Form DH 1896 or its statutory successor.
- “EMS” – Emergency Medical Services personnel operating under Ch. 401, Fla. Stat., including but not limited to paramedics and emergency medical technicians.
- “Good-Faith Standard” – The immunity threshold under which Providers are shielded from civil or criminal liability when relying on a properly executed DNRO absent actual knowledge of revocation.
- “Revocation” – Any oral or written expression by Patient (or Surrogate, where decision-making authority has vested) rescinding this DNRO.
III. OPERATIVE PROVISIONS
3.1 Medical Order Not to Resuscitate
a. Physician ORDERS that no CPR be initiated if Patient suffers cardiac or respiratory arrest.
b. This order extends to all health-care settings, including home, hospital, and transport by EMS.
3.2 Presentation & Form Requirements
a. The original DNRO shall be printed on canary-yellow, letter-size paper.
b. Photocopies, electronic images, and an approved DNRO bracelet/pendant are acceptable substitutes when the original is unavailable.
[// GUIDANCE: EMS protocols instruct personnel to accept legible copies. Attach institutional policy if more restrictive.]
3.3 Scope of Treatment
Providers shall continue all comfort care, pain management, and palliative measures consistent with prevailing standards of care.
3.4 Revocation Procedure
a. Patient (or Surrogate, once decisional authority is transferred) may revoke this DNRO at any time by:
i. Physically destroying the document;
ii. Communicating revocation to any Provider; or
iii. Executing a superseding directive.
b. Upon notice of revocation, Physician shall promptly document the revocation in the medical record and notify relevant Providers.
3.5 Distribution
Copies shall be maintained in:
i. Patient’s medical record;
ii. Patient’s residence in a conspicuous location;
iii. With any transporting EMS agency; and
iv. With Surrogate, if appointed.
IV. REPRESENTATIONS & WARRANTIES
4.1 Patient/Surrogate
a. Represents having reviewed the nature and consequences of a DNRO.
b. Warrants the decision is voluntary and free from duress or undue influence.
4.2 Physician
a. Represents that Patient is either capable of informed consent or that Surrogate decision-making complies with Ch. 765, Fla. Stat.
b. Warrants the medical judgment that CPR would not provide a reasonable expectation of recovery or is inconsistent with Patient’s wishes.
4.3 Providers
Providers relying on this DNRO represent they have verified the document appears facially valid and unrevoked.
V. COVENANTS & RESTRICTIONS
5.1 Patient/Surrogate Covenants
a. To inform family members of the existence of this DNRO.
b. To provide updated copies to new health-care facilities or physicians.
5.2 Physician Covenants
a. To review the continued appropriateness of this DNRO at each significant change in Patient’s condition.
b. To re-issue the order if the Department of Health updates Form DH 1896.
5.3 Provider Restrictions
No Provider shall withhold comfort care, hydration, or nutrition solely by reason of this DNRO unless separately directed under an Advance Directive.
VI. DEFAULT & REMEDIES
6.1 Events of Default
a. Initiation of CPR contrary to this DNRO.
b. Provider refusal to honor a valid DNRO absent statutory exception (e.g., uncertainty of validity).
6.2 Notice & Cure
Patient, Surrogate, or Physician shall notify the defaulting Provider in writing. Provider has twenty-four (24) hours, where feasible, to investigate and implement corrective measures, except where life-saving efforts have already occurred.
6.3 Remedies
a. Injunctive Relief: Immediate court order compelling compliance with DNRO.
b. Reimbursement of reasonable attorneys’ fees and costs incurred in enforcing this DNRO.
VII. RISK ALLOCATION
7.1 Indemnification – Provider Protection
Patient and Surrogate jointly agree to indemnify and hold harmless Providers from any liability, loss, or expense (including reasonable attorneys’ fees) arising out of good-faith compliance with this DNRO, except in cases of gross negligence or willful misconduct.
7.2 Limitation of Liability – Good-Faith Standard
In accordance with Fla. Stat. § 401.45(3), no Provider acting in good faith reliance on this DNRO shall incur civil or criminal liability or be subject to disciplinary action.
7.3 Insurance
[PLACEHOLDER: Insert any facility-specific professional liability insurance requirements if desired.]
7.4 Force Majeure
No party shall be liable for failure to comply where compliance is impossible due to force majeure events rendering the DNRO unavailable at the scene.
VIII. DISPUTE RESOLUTION
8.1 Governing Law
This DNRO and any disputes arising hereunder shall be governed by the laws of the State of Florida without regard to conflict-of-laws principles.
8.2 Forum
Exclusive jurisdiction and venue shall lie in the Circuit Court of the county where Patient resides or, if Patient is institutionalized, the county where the institution is located.
8.3 Arbitration & Jury Waiver
Not applicable.
8.4 Injunctive Relief
Nothing herein limits the right of any party to seek injunctive relief to enforce or stay actions inconsistent with this DNRO.
IX. GENERAL PROVISIONS
9.1 Amendments & Waivers
Any amendment must (i) be in writing, (ii) reference this DNRO, and (iii) be signed by Patient (or Surrogate) and Physician. No waiver is effective unless in writing and signed by the waiving party.
9.2 Assignment
Rights and obligations under this DNRO are personal and non-assignable, except that Surrogate authority may pass to a statutorily authorized successor.
9.3 Severability
If any provision is held invalid, the remaining provisions shall remain enforceable to the fullest extent permitted by law.
9.4 Integration
This DNRO, together with any attached schedules or referenced Advance Directives, constitutes the complete and exclusive statement of Patient’s instructions regarding CPR.
9.5 Counterparts & Electronic Signatures
This DNRO may be executed in counterparts, including facsimile or electronic signatures, each of which shall be deemed an original.
X. EXECUTION BLOCK
[// GUIDANCE: Florida does NOT require notarization for a DNRO, but two witnesses are customary risk-management practice. At least one witness should be disinterested.]
Patient
Signature: ____ Date: __
Printed Name: _____ DOB: _______
Surrogate / Health-Care Proxy (if applicable)
Signature: ____ Date: __
Printed Name: _____ Relationship: ______
Attending Physician (Florida-Licensed MD/DO)
Signature: ____ Date: __
Printed Name: _____ License No.: ______
Witness #1 (Disinterested)
Signature: ____ Date: __
Printed Name: _____
Witness #2
Signature: ____ Date: __
Printed Name: _____
[// GUIDANCE:
1. PRINT THIS DOCUMENT ON CANARY-YELLOW PAPER BEFORE FINAL SIGNING to ensure EMS recognition.
2. Attach copies of any Living Will or Health-Care Surrogate Designation for comprehensive guidance.
3. Counsel clients to present the DNRO to each new health-care provider and to retain a digital image on a mobile device for emergent situations.]