2017 Colorado Revised Statutes
Title 15 - Probate, Trusts, and Fiduciaries
Declarations - Future Medical Treatment
Article 18.7 - Directives Concerning Medical Orders for Scope of Treatment
§ 15-18.7-103. Medical orders for scope of treatment forms - form contents
(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:
(a) The adult's name, date of birth, and sex;
(b) The adult's eye and hair color;
(c) The adult's race or ethnic background;
(d) If applicable, the name of the hospice program in which the adult is enrolled;
(e) The name, address, and telephone number of the adult's physician, advanced practice nurse, or physician assistant;
(f) The adult's signature or mark or, if applicable, the signature of the adult's authorized surrogate decision-maker;
(g) The date upon which the medical orders for scope of treatment form was signed;
(h) The adult's instructions concerning:
(I) The administration of CPR;
(II) Other medical interventions, including but not limited to consent to comfort measures only, transfer to a hospital, limited intervention, or full treatment; and
(III) 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.
