(1) A medical orders for scope of treatment form shall include the following information concerning the adult whose medical treatment is the subject of the medical orders for scope of treatment form:
The adult's name, date of birth, and sex;
The adult's eye and hair color;
The adult's race or ethnic background;
If applicable, the name of the hospice program in which the adult is enrolled;
The name, address, and telephone number of the adult's physician, advanced practice nurse,or physician assistant;
The adult's signature or mark or, if applicable, the signature of the adult's authorized surrogate decision-maker;
The date upon which the medical orders for scope of treatment form was signed;(h) The adult's instructions concerning:
The administration of CPR;
Other medical interventions, including but not limited to consent to comfort measures only,transfer to a hospital, limited intervention, or full treatment; and
Other treatment options;
(i) The signature of the adult's physician, advanced practice nurse, or, if under the supervision or authority of the physician, physician assistant.
Source: L. 2010: Entire article added, (HB 10-1122), ch. 279, p. 1278, § 1, effective August 11. L. 2016: (1)(e) and (1)(i) amended, (SB 16-158), ch. 204, p. 725, § 11, effective August 10.
Cross references: For the legislative declaration in SB 16-158, see section 1 of chapter 204, Session Laws of Colorado 2016.