How to Use This Site This companion website provides links to official forms, government resources, and medical references supporting the content found here. It is organized to help you find what you need quickly, whether that is an advance directive form for your state, an explanation of brain death laws, or the published research behind the book's guidance. Start with whatever section matches your most pressing concern.

Printable Forms & Downloads

These forms are referenced in the book's appendix and are provided here as free printable downloads. Since there is no way to print from a paper book, Kindle, or audiobook, this page is the best source for current printable versions. Forms may be updated from time to time, so check back for the latest versions.

Patient Tracking Form

A two-page form for organizing your loved one's ICU stay. Page one captures the patient summary (demographics, medical history, medications, allergies, code status, advance directive, and the patient's expressed wishes). Page two is a daily log you can print multiple copies of to track each day's plan, changes, questions asked, answers received, and your observations. Keep it at the bedside or in a folder you bring to every visit.

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Daily Rounds Preparation Checklist

A one-page checklist to fill out before rounds each morning. Covers what you observed since the last update, key numbers (vasopressors, oxygen, urine output), your single most important question for the attending, backup questions, unresolved concerns, and space to write down what you heard at rounds. Takes under five minutes. Print a fresh copy each day.

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Tip Print the Patient Summary page once and update it as things change. Print several copies of the Daily Log page so you have a fresh one for each day or shift. Write down every question you ask and every answer you receive. If you did not get an answer, write that down too. This record will be invaluable if you need to advocate for your family member or consult with outside physicians.

Chapter-by-Chapter Guide

ICU Family Resource is organized so that you can go straight to the chapter that matches what your family is facing. You do not need to read it front to back. Use this overview to find where to start.

Start Here Based on Your Situation

Just Admitted? On a Ventilator? Confused / Delirious? Facing Big Decisions? Getting Worse? Leaving the ICU? Advance Planning?

1
What the ICU Actually Is
Four levels of hospital care, why patients look worse in the ICU, key vital sign basics.
2
Who Is in Charge
Intensivists, hospitalists, consultants, NPs and PAs. Closed vs. open ICU models.
3
The First 24-72 Hours
What just happened, diagnostic uncertainty, how clinicians think about time and probability.

4-6
Respiratory Failure, Ventilators & Sedation
Why patients are intubated, the ventilator as support (not cure), sedation holidays, spontaneous breathing trials.
7-8
Rounds, the Daily Plan & Communication
How rounds work, how the daily plan is formed and changed, what to do if something feels wrong.

9-10
The Room, Alarms, Lines & Tubes
Why alarms sound constantly, what is normal vs. concerning, central lines, drains, and monitoring.
14
Sedation, Delirium & Brain Function
The CAM-ICU tool, the ABCDEF bundle, what families can do to help with delirium prevention.

26-28
Consent, Capacity & Surrogate Decision-Making
Informed consent in the ICU, substituted judgment vs. best interest, fluctuating capacity, what families can do.
29
Code Status & Goals of Care
What a code actually is, DNR and DNI explained, the larger goals-of-care conversation, the legal and ethical framework.
30-31
Brain Death, Persistent Vegetative State & End of Life
What brain death means medically and legally, the doctrine of double effect, what the family will see.

11
Recognizing When Treatment Is No Longer Helping
How to interpret escalation, setbacks vs. trajectory.
15-20
Organ-Specific Complications
ARDS, neuromuscular blockade, shock and vasopressors, mechanical support (IABP, ECMO), kidney injury and dialysis, blood clots, nutrition.

33-34
Transfer Out of the ICU & Bounce-Back
Stepdown vs. floor, what changes, the emotional reality of leaving, warning signs to watch for.
35-37
Long-Term Recovery & Post-ICU Syndrome
PICS (physical, cognitive, psychological), survivor clinics, caregiver burden, rehabilitation options.

39-40
Advance Directives & Preparing Before a Crisis
Why advance directives matter, where to store them, five questions everyone should answer.

Florida Advance Directive & DNR Forms

Florida law (Chapter 765, Florida Statutes) recognizes three types of advance health care directives: a living will, a designation of health care surrogate, and an anatomical donation. These forms are free and do not require a lawyer or notary. Two witnesses are required, and at least one witness must not be a spouse or blood relative.

Legal Disclaimer The forms linked below are provided for informational purposes only. This website does not provide legal advice. Laws change, and individual circumstances vary. You should consult a qualified Florida attorney for advice specific to your situation. The authors and publishers of this site accept no liability for actions taken based on information found here. Always verify that you are using the most current version of any legal form.

Florida Advance Directive (Combined Form)

Includes Living Will, Health Care Surrogate Designation, and Anatomical Donation. From CaringInfo, a program of the National Alliance for Care at Home. Approved form language per Florida Statutes.

Download PDF

Florida Health Care Advance Directives (State Guide)

Official consumer guide from the Florida Agency for Health Care Administration (AHCA), including sample forms approved by the Supreme Court of Florida.

View Guide & Forms

Florida Do Not Resuscitate Order (DNRO)

Official Form DH 1896 from the Florida Department of Health. Must be printed on yellow paper to be legally valid. Requires signatures from patient (or authorized representative) and physician.

FL Dept. of Health DNRO Page

Florida POLST Form

Physician Orders for Life-Sustaining Treatment. A medical order (not just a directive) signed by your physician that EMS must follow. Appropriate for seriously ill patients.

National POLST Directory

The Florida Bar: Living Wills & Health Care Surrogates

Consumer information page from The Florida Bar explaining advance directives under Florida law, with links to approved forms.

Florida Bar Guide

Florida Statutes Chapter 765

Full text of Florida's Health Care Advance Directives law, including surrogate designation (765.202), living will (765.302), and decision-making priority list.

Read the Statute

Florida-Specific Notes In Florida, if you have not designated a surrogate and become incapacitated, the law establishes a priority order for who may make decisions: spouse, then adult child (majority of those available), then parent, then adult sibling, then adult relative with special care and concern, then a close friend, then a licensed clinical social worker. The DNRO is distinct from a hospital DNR order. The DNRO is specifically for pre-hospital (EMS/paramedic) settings and must be on yellow paper. A hospital DNR is placed in your chart by your physician.

DNR & Advance Directive Forms by State

Every state has its own forms, requirements, and terminology for do-not-resuscitate orders and advance directives. Some states require specific colored paper, physician signatures, witnesses, or notarization. Use the links below to find official or widely-accepted forms for each state.

Legal Disclaimer State laws governing advance directives and DNR orders change frequently. The links below are provided as a starting point and were verified as of early 2026. Always confirm that you are using your state's most current official form. Consult an attorney licensed in your state for legal advice. This site is not a substitute for professional legal or medical counsel.

State	Advance Directive / Living Will	DNR / POLST Form	Notes
Alabama	CaringInfo	DNR Form	Uses "Do Not Attempt Resuscitation" terminology
Alaska	CaringInfo	DNR Form	Comfort One program for pre-hospital DNR
Arizona	CaringInfo	DNR Form	Prehospital Medical Care Directive
Arkansas	CaringInfo	DNR Form	POLST program active
California	CaringInfo	CA EMS Authority	POLST on pink paper; separate prehospital DNR form
Colorado	CaringInfo	DNR/CPR Directive	MOST (Medical Orders for Scope of Treatment)
Connecticut	CaringInfo	DNR Form
Delaware	CaringInfo	DNR Form	DMOST program
Florida	FL AHCA	FL DOH DNRO	DNRO must be on yellow paper. POLST also available.
Georgia	CaringInfo	DNR Form	Georgia POLST program active
Hawaii	CaringInfo	DNR Form	Comfort Care Only / DNR program
Idaho	CaringInfo	DNR Form	POST (Physician Orders for Scope of Treatment)
Illinois	CaringInfo	DNR Form	IDPH Uniform DNR Advance Directive; POLST active
Indiana	CaringInfo	DNR Form	Out-of-Hospital DNR; POST program
Iowa	CaringInfo	DNR Form	IPOST (Iowa Physician Orders for Scope of Treatment)
Kansas	CaringInfo	DNR Form	First state to enact brain death statute
Kentucky	CaringInfo	DNR Form
Louisiana	CaringInfo	DNR Form	LaPOST active
Maine	CaringInfo	DNR Form	Comfort Care / DNR program; POLST active
Maryland	CaringInfo	DNR Form	MOLST program active
Massachusetts	CaringInfo	MA MOLST/DNR	Transitioning from MOLST to POLST model
Michigan	CaringInfo	DNR Form	MI POST program
Minnesota	CaringInfo	DNR Form	POLST program active
Mississippi	CaringInfo	DNR Form	DNR Order-Bracelet Act
Missouri	CaringInfo	DNR Form	TPOPP (Transportable Physician Orders for Patient Preferences)
Montana	CaringInfo	DNR Form	POLST active
Nebraska	CaringInfo	DNR Form
Nevada	CaringInfo	NV POLST/DNR	POLST active; Living Will Lockbox registry via Secretary of State
New Hampshire	CaringInfo	DNR Form	POLST active
New Jersey	CaringInfo	DNR Form	Religious accommodation for brain death objections required by law; POLST active
New Mexico	CaringInfo	DNR Form	MOST program
New York	CaringInfo	DNR Form	MOLST; religious accommodation for brain death at hospital discretion
North Carolina	CaringInfo	NC OEMS DNR/MOST	DNR on goldenrod paper; MOST on pink paper. Forms only from authorized facilities.
North Dakota	CaringInfo	DNR Form	POLST active
Ohio	CaringInfo	DNR Form	DNR Comfort Care and DNR Comfort Care-Arrest forms
Oklahoma	CaringInfo	DNR Form
Oregon	CaringInfo	Oregon POLST	Founding POLST state (1991); statewide registry available
Pennsylvania	CaringInfo	DNR Form	Out-of-Hospital DNR; POLST active
Rhode Island	CaringInfo	DNR Form	Comfort Care Order
South Carolina	CaringInfo	DNR Form
South Dakota	CaringInfo	DNR Form
Tennessee	CaringInfo	DNR Form	POST (Physician Orders for Scope of Treatment)
Texas	CaringInfo	DNR Form	Out-of-Hospital DNR; unique medical futility statute (Sec. 166.046)
Utah	CaringInfo	DNR Form	POLST active
Vermont	CaringInfo	DNR Form	COLST (Clinician Orders for Life-Sustaining Treatment)
Virginia	CaringInfo	DNR Form	POST program active
Washington	CaringInfo	WA POLST	POLST is only form honored by EMS in WA; no bracelets or pocket cards accepted
West Virginia	CaringInfo	DNR Form	POST program
Wisconsin	CaringInfo	DNR Form
Wyoming	CaringInfo	DNR Form
Washington D.C.	CaringInfo	eForms Directory

AARP Free Advance Directive Forms

Free state-by-state advance directive forms with instructions, maintained by AARP. Covers all 50 states and territories.

AARP Forms Directory

CaringInfo State-by-State Forms

CaringInfo (National Alliance for Care at Home) provides free advance directive downloads for every state with instructions for completing them.

CaringInfo Directory

National POLST Directory

Official directory of POLST/MOLST/MOST/POST programs in every state, including form downloads and program status. From the National POLST Collaborative.

POLST State Programs

Brain Death: Laws, Standards & State Variations

Brain death (death by neurologic criteria) is legally recognized in all 50 states, but laws and institutional protocols vary significantly. Understanding these differences matters when a family is told their loved one has been declared brain dead, or when testing is being discussed.

Key Facts All 50 states recognize brain death as legal death. Thirty-eight states have adopted the Uniform Determination of Death Act (UDDA) or very similar language. The 2023 AAN/AAP/CNS/SCCM guidelines represent the current accepted medical standard for brain death determination. However, only two states (Nevada and, to a lesser extent, New Jersey) have specified which medical guidelines must be followed in their statutes. Brain death testing protocols, the number of required physicians, required qualifications, observation periods, and accommodation policies for religious objections all differ from state to state and sometimes from hospital to hospital.

UDDA State-by-State Survey (PMC)

Comprehensive legal survey of brain death laws in all 50 states, published in the Linacre Quarterly. Examines which states adopted the UDDA verbatim vs. with modifications.

Read the Survey

2023 Brain Death Consensus Guideline

The AAN/AAP/CNS/SCCM Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Guideline, published in Neurology (2023).

View Guideline

AMA Journal of Ethics: Criteria Mismatch

Discussion of the gap between legal definitions and diagnostic testing for brain death, and why this matters for families and clinicians.

Read the Article

ICU Controversies in Brain Death (PMC)

Legal and ethical implications of brain death in the ICU. Covers high-profile cases (Jahi McMath, Aden Hailu) and state-by-state legal variations.

Read the Review

States with Religious Accommodations

New Jersey requires hospitals to accommodate religious objections to brain death determination. New York, California, and Illinois have similar but less binding provisions.

Harvard Petrie-Flom Analysis

Medical Liability: State Variations Explained

Detailed discussion of how brain death determination requirements (number of doctors, qualifications, waiting periods) differ from state to state.

Listen / Read

Additional Resources

Leapfrog Hospital Safety Grade

Free A-F safety grades for nearly 3,000 U.S. hospitals. Search by hospital name or location. Referenced for evaluating hospital quality.

Search Hospital Grades

Johns Hopkins Hospital Safety

Armstrong Institute for Patient Safety and Quality. Pioneering research in ICU checklists, infection prevention, and patient safety culture.

Armstrong Institute

Society of Critical Care Medicine (SCCM)

Professional society for ICU physicians, nurses, and allied health. Patient and family resources including the ICU liberation (ABCDEF) bundle.

MyICUCare

ICU Steps (Patient & Family Support)

Non-profit support organization for ICU patients and families. Information booklets, peer support, and resources for PICS (Post-Intensive Care Syndrome).

ICU Steps

U.S. Dept. of Health & Human Services: State Aging Resources

State-by-state directory of aging services, which can assist with prehospital DNR forms and advance care planning resources.

HHS State Resources

Goals of Care Conversation Guide

The Conversation Project offers free starter kits to help families discuss wishes before a crisis occurs. Available in multiple languages.

The Conversation Project

Selected References from the Book

ICU Family Resource is grounded in peer-reviewed medical literature. Below is a selection of key references cited in the book, organized by topic, with links where available.

ICU Organization & Safety

Pronovost PJ, et al. "Implementing and Validating a Comprehensive Unit-Based Safety Program." Journal of Patient Safety. 2005.
Kahn JM, et al. "Hospital Volume and the Outcomes of Mechanical Ventilation." NEJM, 355(1):41-50, 2006.
Joint Commission. "Sentinel Event Alert: Inadequate Hand-off Communication." Issue 58, 2017.
Starmer AJ, et al. "Changes in Medical Errors after Implementation of a Handoff Program." NEJM, 371(19):1803-12, 2014.
Detsky ME, Etchells E. "Morbidity and Mortality Rounds." JAMA, 293(3):351, 2005.

Ventilators, Sedation & Weaning

Esteban A, et al. "Characteristics and Outcomes in Adult Patients Receiving Mechanical Ventilation." JAMA, 288(17):2151-62, 2002.
Kress JP, et al. "Daily Interruption of Sedative Infusions in Critically Ill Patients." NEJM, 342(20):1471-77, 2000.
Girard TD, et al. "Efficacy and Safety of a Paired Sedation and Ventilator Weaning Protocol." Lancet, 371(9607):126-34, 2008.
Epstein SK. "Decision to Extubate." Intensive Care Medicine, 28(5):535-46, 2002.
Scheinhorn DJ, et al. "Post-ICU Mechanical Ventilation at 23 Long-term Care Hospitals." Chest, 131(1):85-93, 2007.

Delirium & Neurocognitive Outcomes

Ely EW, et al. "Evaluation of Delirium in Critically Ill Patients: Validation of the CAM-ICU." JAMA, 286(21):2703-10, 2001.
Pandharipande P, et al. "Long-Term Cognitive Impairment after Critical Illness." NEJM, 369(14):1306-16, 2013.
Devlin JW, et al. "Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult ICU Patients." Critical Care Medicine, 46(9):e825-e873, 2018.
Balas EA, Boren SA. "Managing Clinical Knowledge for Health Care Improvement." Yearbook of Medical Informatics, 2000.

Shock, Organ Support & Resuscitation

Kumar A, et al. "Duration of Hypotension Before Initiation of Effective Antimicrobial Therapy Is the Critical Determinant of Survival in Human Septic Shock." Critical Care Medicine, 34(6):1589-96, 2006.
Sandroni C, et al. "In-hospital Cardiac Arrest: Survival Depends Mainly on the Effectiveness of the Emergency Response." Resuscitation, 62(3):291-97, 2004.
Krischer JP, et al. "Complications of Cardiac Resuscitation." Chest, 92(2):287-91, 1987.
Nielsen N, et al. "Targeted Temperature Management at 33 vs 36 Degrees." NEJM, 369(23):2197-206, 2013.

Post-ICU Recovery & Survivorship

Needham DM, et al. "Improving Long-Term Outcomes After Discharge from Intensive Care Unit." Critical Care Medicine, 40(2):502-09, 2012.
Davydow DS, et al. "Depression in General ICU Survivors: A Systematic Review." Intensive Care Medicine, 30(5):421-34, 2009.
Rosenberg AL, Watts C. "Patients Readmitted to ICUs: A Systematic Review." Chest, 118(2):492-502, 2000.
Herridge MS, et al. "Functional Disability 5 Years After ARDS." NEJM, 364(14):1293-304, 2011.

End-of-Life, Ethics & Legal Framework

Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990).
Pew Research Center. "More Americans Discussing and Planning End-of-Life Treatment." 2006.
Owen AM, et al. "Detecting Awareness in the Vegetative State." Science, 313(5792):1402, 2006.
President's Commission for the Study of Ethical Problems in Medicine. "Defining Death: Medical, Legal and Ethical Issues in the Determination of Death." 1981.

Frequently Asked Questions

A Living Will is a legal document that states your wishes about medical treatment (ventilators, feeding tubes, etc.) if you become incapacitated with a terminal condition, end-stage condition, or persistent vegetative state. It does not require a physician's signature. A DNR (Do Not Resuscitate) order is a physician's order directing that CPR not be performed if your heart stops or you stop breathing. It is narrow in scope, addressing only resuscitation. A POLST (Physician Orders for Life-Sustaining Treatment) is a broader medical order, signed by both the patient and physician, covering CPR, ventilation, antibiotics, and nutrition. POLST is intended for seriously ill patients and is immediately actionable by EMS. A living will tells people what you want. A DNR and POLST tell medical professionals what to do.

Florida law (Section 401.45, F.S., and Rule 64J-2.018, F.A.C.) specifically requires the DNRO to be printed on yellow paper so that paramedics and EMTs can immediately recognize it in an emergency. A DNRO on white or any other color paper is not legally valid and EMS is not required to honor it. The yellow color serves as a rapid visual signal in high-stress, time-critical situations. Any shade of yellow is acceptable. A wallet-sized version can be cut from the bottom of the form, laminated, and carried on your person.

Brain death is the irreversible cessation of all functions of the entire brain, including the brain stem. It is legal death in all 50 states. However, the specific testing protocols, number of required examinations, required physician qualifications, observation periods, and policies for religious accommodation vary from state to state and sometimes from hospital to hospital. Thirty-eight states have adopted the Uniform Determination of Death Act (UDDA), but even among those states there are differences in implementation. New Jersey is the only state that requires hospitals to make a religious exemption when families object to brain death on religious grounds. New York, California, and Illinois have some form of accommodation policy, but it is less standardized.

If the patient made the DNR decision while competent, family members generally cannot override it. The DNR reflects the patient's own autonomous decision. However, if the patient later expresses a desire to be resuscitated (verbally or in writing), or if the patient destroys the DNR form, the order is revoked. In practice, if family members arrive at a scene and urgently request resuscitation and no DNR is presented, EMS will typically proceed with CPR. The best protection for having your wishes followed is ensuring your DNR, advance directive, and surrogate designation are properly completed, widely distributed, and easily accessible.

The ABCDEF bundle is an evidence-based framework for ICU care that reduces delirium, shortens ventilator time, and improves long-term outcomes. It stands for: A - Assess, prevent, and manage pain; B - Both spontaneous awakening trials and spontaneous breathing trials; C - Choice of analgesia and sedation; D - Delirium: assess, prevent, and manage; E - Early mobility and exercise; F - Family engagement and empowerment. Families can actively participate in F by being present, speaking to the patient, asking about the daily plan, and advocating for early mobility when appropriate.

PICS refers to the physical, cognitive, and psychological impairments that persist after an ICU stay. Physical effects may include muscle weakness and fatigue. Cognitive effects can include memory problems, difficulty concentrating, and in some cases impairment resembling mild Alzheimer's disease. Psychological effects include depression, anxiety, and PTSD. Research by Pandharipande, Needham, and others has shown these effects can last months to years. PICS also affects family members (PICS-F), who may experience their own depression, anxiety, and complicated grief. Survivor clinics and structured follow-up programs are increasingly available to help.

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About the Author

Dr. Donald Elton is a board-certified pulmonary physician (FCCP) who has practiced critical care medicine for over 40 years across multiple hospitals and states. His career in the ICU began as a respiratory therapist before he became a physician, giving him a perspective on critical care that spans every level of the bedside team. He served as Chief of Staff during the COVID-19 pandemic and has spent decades managing ventilators, guiding families through the most difficult decisions of their lives, and observing firsthand the gap between what families need to know and what they are typically told. ICU Family Resource is the book he wished every family had when they walked through the ICU doors for the first time.

Dr. Elton is also the author of fiction and nonfiction spanning multiple genres and languages, published under the EltonBooks brand. His work draws on his medical expertise, his background as an instrument-rated pilot and former software engineer, and his deep knowledge of Latin American history and culture.

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