Florida Patient Directed Medical Order (PDMO) 2026 Explained

If your spouse or parent had a Do Not Resuscitate Order (DNRO) on file — that yellow piece of paper from the Florida Department of Health — you need to know that Florida's end-of-life directive system changed significantly in 2026. Senate Bill 312 (SB 312), effective this year, introduced the Patient-Directed Medical Order (PDMO), a new framework that replaces the older single-intervention DNRO for many patients and creates a statewide electronic database managed by the Agency for Health Care Administration (AHCA).

If you are dealing with the aftermath of a death, or helping an aging parent document their end-of-life wishes now, understanding the PDMO versus the old DNRO is essential.

What the Old DNRO Was — and Its Limits

For decades, Florida's standard end-of-life order was the Do Not Resuscitate Order (DNRO), printed on yellow paper and designated as DH Form 1896 by the Florida Department of Health. It was a single-purpose document: it directed emergency medical personnel and healthcare providers not to attempt cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest.

The DNRO had significant practical limitations. It covered only one intervention (resuscitation) and required the physical yellow document to be immediately accessible. If the document was locked in a filing cabinet when paramedics arrived, or if the patient was transferred between facilities, the order could easily be overlooked or ignored. There was no centralized system for hospitals, hospices, and EMS services to verify whether a patient had a DNRO on file.

What the 2026 PDMO Changes

The Patient-Directed Medical Order created by SB 312 is a fundamentally different instrument. Rather than addressing only resuscitation, the PDMO is a comprehensive medical order governing the withholding or withdrawing of multiple life-prolonging procedures. It can address artificial nutrition and hydration, mechanical ventilation, hospitalization preferences, and comfort-focused care — all in a single, legally recognized document.

Key features of the 2026 PDMO:

AHCA Electronic Database SB 312 requires AHCA to maintain a secure electronic database for PDMO storage. Healthcare providers — including emergency medical services, hospitals, and hospice facilities — are expected to query this database when treating a patient to confirm whether a valid PDMO exists. This eliminates the yellow-paper problem: the order travels with the patient digitally, regardless of which facility they are in.

Who Can Sign It To be valid, a PDMO must be signed by a licensed physician, a physician assistant, or an autonomous advanced practice registered nurse (APRN). The patient (or their health care surrogate) initiates the order and their medical provider executes it.

Relationship to Other Directives The PDMO is separate from a Florida Living Will (which is an advance directive that generally takes effect when the patient lacks decision-making capacity and is in a terminal condition). The PDMO is an actionable medical order that EMS and clinical staff follow immediately upon presentation or database confirmation. You can have both documents; they serve different functions.

Privacy Concerns With the PDMO Database

There is one significant unresolved issue with the 2026 PDMO framework. When SB 312 was passed, no companion public records exemption bill was enacted alongside it. This creates legal uncertainty about whether PDMO records stored in the AHCA database could be subject to Florida's Sunshine Law, which broadly requires state agency records to be available for public inspection.

End-of-life directives contain deeply sensitive medical and personal information. Families should consult with a Florida healthcare attorney regarding the privacy implications before submitting a PDMO to the state database. The alternative — relying on a physical DNRO — avoids the database entirely, though it comes with the practical limitations described above.

If Your Spouse or Parent Had an End-of-Life Directive

When a death occurs, here is what to do with existing end-of-life directives:

Within the first days: Notify the deceased's healthcare providers and hospice of the death. If a PDMO was in the AHCA database, no action is required to "deactivate" it, but the provider should document the death in the patient's records.

Original documents: Retain the original PDMO or DNRO documents. They may be relevant if any questions arise about treatment decisions near the time of death, and they form part of the medical record that can be requested from providers.

Living Will: A Florida Living Will (the broader advance directive) does not need to be filed with any court after death. It becomes legally inoperative upon death. However, keep a copy with the estate paperwork in case any questions arise later.

Setting Up End-of-Life Directives for Yourself After a Loss

Many surviving spouses, prompted by their partner's death, realize they need to get their own affairs in order. Florida's 2026 changes make this a good time to do it properly.

Florida Living Will: Documents your healthcare wishes if you are in a terminal condition and cannot make decisions. It should be signed before two witnesses (neither of whom can be your spouse or blood relative, or your healthcare provider) and does not require notarization, though notarization adds an extra layer of protection.

Designation of Health Care Surrogate: Names a person who can make medical decisions on your behalf if you are incapacitated. This is separate from a durable power of attorney, which covers financial decisions.

PDMO: If you have a specific condition — advanced terminal illness, end-stage organ failure, severe irreversible dementia — and want granular control over life-prolonging interventions, work with your physician to execute a PDMO. Discuss with your attorney whether to register it in the AHCA database or keep it as a physical document given the current privacy uncertainties.

Durable Power of Attorney: Designates someone to manage your financial affairs if you are incapacitated. This is a critical piece of estate planning that many people defer and should not.

How This Fits Into the Broader Florida Estate Plan

End-of-life directives are not a substitute for a will or trust, but they are part of the complete picture. A surviving spouse who just lost a partner is often simultaneously dealing with healthcare paperwork from the deceased's final months, probate filings, and the realization that their own affairs are not organized.

If you are in that position — settling an estate while trying to get your own planning in order — the Florida Survivor Benefits Navigator provides a structured roadmap: what to claim now, what deadlines to meet, and how to organize the estate before it becomes a crisis.

See more Florida guides →