Colorado Revised Statutes Title 15. Probate, Trusts, and Fiduciaries § 15-18.7-103. Medical orders for scope of treatment forms--form contents

(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 registered 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 signature of the adult's physician, advanced practice registered nurse, or physician assistant.