DO NOT RESUSCITATE ORDER - Florida Department of Health 2026

1. Click ‘Get Form’ to open the DO NOT RESUSCITATE ORDER in our editor.
2. Begin by entering the patient’s full legal name and date of birth in the designated fields at the top of the form.
3. In the Patient’s (or Authorized Person’s) Statement section, indicate your understanding of your right to refuse CPR. Sign and date this section as either the patient or an authorized person.
4. If you are signing on behalf of the patient, specify your relationship by checking the appropriate box (principal, surrogate, proxy, etc.) and provide your printed name.
5. Next, in the Health Care Provider’s Statement section, enter the provider's full legal name and license number. The provider must sign and date this section as well.
6. Ensure all information is accurate before saving or printing. Remember that a copy printed on yellow paper is valid as the original.

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