Seriously ill or frail Floridians can have their treatment choices recorded as portable physician orders on this voluntary form, maintained by FMDA, the Florida Society for Post-Acute and Long-Term Care Medicine, rather than by the state. The physician records CPR status, full, limited or comfort-only interventions, artificially administered nutrition and hospice or palliative enrollment after discussing benefits, burdens and preferences. Physician and patient or surrogate both sign.
A physician (MD or DO) completes Sections A through D and signs; the patient or health care surrogate or proxy also signs, and Section E documents who took part in the discussion.
Download the current version from the source each time; forms change without notice.
Physician Orders for Life-Sustaining Treatment (POLST)-Florida
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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Florida has no POLST statute, and the form is maintained by FMDA rather than the state. For EMS to honor a do-not-resuscitate decision outside the hospital, Florida requires the Department of Health DNRO form (DH 1896) or the patient identification device.
The form must be signed by a physician (MD or DO) to be valid, and by the patient, resident or health care surrogate or proxy. Verbal orders are acceptable with a follow-up physician signature in line with facility or community policy. The current version is dated July 10, 2015.