A nurse practitioner can sign a DNR in Florida, but only if that nurse practitioner is registered for autonomous practice under state law. A nurse practitioner working under physician supervision cannot sign one independently. The distinction is narrow, and it trips up patients and families who assume any advanced practice nurse qualifies.
The Autonomous Practice Requirement
Florida Statute § 401.45, the law governing DNR orders, authorizes “the patient’s physician or physician assistant” to sign.1Florida Senate. Florida Code 401.45 – Denial of Emergency Treatment The statute does not name advanced practice registered nurses. Signing authority for APRNs comes from a separate provision.
Florida Statute § 464.0123 establishes autonomous practice for qualified APRNs. An autonomous APRN may “provide a signature, certification, stamp, verification, affidavit, or endorsement that is otherwise required by law to be provided by a physician.”2Online Sunshine. Florida Statutes 464.0123 – Autonomous Practice by an Advanced Practice Registered Nurse That operates on § 401.45 to extend DNR signing authority to autonomous APRNs.
Florida’s administrative code makes it explicit. Rule 64J-2.018 states that a DNR order “must be signed by the patient’s physician, osteopathic physician, autonomous advanced practice registered nurse, or physician assistant.”3Legal Information Institute. Florida Administrative Code R. 64J-2.018 – Do Not Resuscitate Order Form and Device The official state form, DH 1896, includes a checkbox for “autonomous practice registered nurse” alongside the boxes for physician and physician assistant.4Florida Department of Health. Form DH 1896 – Do Not Resuscitate Order
Autonomous practice itself is limited. Under § 464.0123, it covers primary care fields such as family medicine, general pediatrics, and general internal medicine.2Online Sunshine. Florida Statutes 464.0123 – Autonomous Practice by an Advanced Practice Registered Nurse A nurse practitioner in a specialty outside primary care, or one who practices under a physician’s supervision, does not qualify. If you are not sure whether your nurse practitioner is registered for autonomous practice, ask directly before you rely on them to sign the form.
Who Else Can Sign a Florida DNR
If your nurse practitioner cannot sign, the order can still be signed by any of the other providers the rule lists:
- A physician (MD)
- An osteopathic physician (DO)
- A physician assistant (PA)
These are the only providers whose signature a Florida DNR will accept. A hospital chart note, a letter from a doctor, or an entry by an unauthorized provider will not substitute.
What Makes the DNR Order Valid
Having the right signature is only part of it. A Florida DNR is enforceable only when the formal requirements are met, and EMS personnel are not obligated to honor an order that falls short.
The Official Form
The order must appear on DH Form 1896, which is incorporated by Rule 64J-2.018.5Florida Department of Health. Do Not Resuscitate Order You can download it from the Florida Department of Health. No other document works in its place.
Yellow Paper
The form must be printed on yellow paper before it is completed. Any shade of yellow is acceptable. An EMT or paramedic is not required to withhold CPR if the form is not on yellow paper, if the content has been altered from the original, or if the printed text is not legible. Copies are valid, including photocopies and electronic reproductions from a medical record, as long as they accurately reproduce the original on yellow paper, including the handwriting and signatures.3Legal Information Institute. Florida Administrative Code R. 64J-2.018 – Do Not Resuscitate Order Form and Device
Two Signatures
The provider signs, and the patient also signs if they have the capacity to make the decision.4Florida Department of Health. Form DH 1896 – Do Not Resuscitate Order Florida does not require notarization, and the form has no witness fields.
When the Patient Cannot Sign
If the patient lacks capacity, someone legally authorized to make healthcare decisions can sign in their place. Florida recognizes four categories:
- A healthcare surrogate the patient previously designated in writing.
- A healthcare proxy selected by the patient’s attending physician under Chapter 765 when no surrogate has been designated.
- A court-appointed guardian under Chapter 744 who has been delegated authority to make healthcare decisions.
- An agent under a durable power of attorney under Chapter 709 who is expressly authorized to make healthcare decisions.
A guardian or agent whose authority covers only financial matters cannot sign a DNR. The healthcare authority has to be specifically delegated.1Florida Senate. Florida Code 401.45 – Denial of Emergency Treatment
Keeping the Order Available in an Emergency
A DNR directs EMTs and paramedics not to perform CPR if you suffer cardiac or respiratory arrest. That includes chest compressions, artificial ventilation, defibrillation, and intubation. It does not refuse all treatment. Pain management, comfort care, and treatment of underlying conditions continue.
The order only works if responders can find it. At home, keep the original visible, such as on the refrigerator or near the bed. In a hospital or nursing facility, it belongs in a prominent place in the medical record. The administrative code also provides for a wallet-sized DNRO Device that can be cut from the bottom of Form DH 1896 and carried on the person.3Legal Information Institute. Florida Administrative Code R. 64J-2.018 – Do Not Resuscitate Order Form and Device If EMS arrives and cannot locate the form, they will perform CPR.
Changing Your Mind
A patient with capacity can revoke a DNR at any time. You can tell your provider orally, put the revocation in writing, or physically destroy the form. Simply not presenting the form when EMS arrives has the same practical effect: responders will treat the situation as if no DNR exists and begin resuscitation. Florida’s framework treats your most recent expressed wish as controlling.