1. (1) A medical orders for scope of treatment form must include the following information concerning the adult whose medical treatment is the subject of the medical orders for scope of treatment form:

   1. (a) The adult's name, date of birth, and sex;
   2. (b) The adult's eye and hair color;
   3. (c) The adult's race or ethnic background;
   4. (d) If applicable, the name of the hospice program in which the adult is enrolled;
   5. (e) The name, address, and telephone number of the adult's physician, advanced practice registered nurse, or physician assistant;
   6. (f) The adult's signature or mark or, if applicable, the signature of the adult's authorized surrogate decision-maker;
   7. (g) The date upon which the medical orders for scope of treatment form was signed;

   8. (h) The adult's instructions concerning:

      1. (I) The administration of CPR;
      2. (II) Other medical interventions, including but not limited to consent to comfort measures only, transfer to a hospital, limited intervention, or full treatment; and
      3. (III) Other treatment options;
   9. (i) The signature of the adult's physician, advanced practice registered nurse, or 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. L. 2023: IP(1) and (1)(i) amended, (SB 23-083), ch. 114, p. 415, § 11, effective August 7.

Cross references: For the legislative declaration in SB 16-158, see section 1 of chapter 204, Session Laws of Colorado 2016.