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In North Carolina, the Do Not Resuscitate (DNR) Order form plays a crucial role in guiding medical professionals and family members regarding a patient’s wishes in the event of a medical emergency. This legally binding document allows individuals to express their desire to forgo cardiopulmonary resuscitation (CPR) and other life-saving measures when faced with a terminal illness or an irreversible condition. It is essential for patients to understand that the DNR form must be completed and signed by a physician, ensuring that it reflects a well-considered decision made in consultation with medical advice. Additionally, the form is designed to be easily recognizable, featuring a distinctive bright yellow color that alerts emergency responders to its presence. Patients can initiate this process through discussions with their healthcare providers, who can offer guidance on the implications and ensure that the form accurately represents their healthcare preferences. By having a DNR Order in place, individuals can maintain a sense of control over their medical treatment, relieving their loved ones of the burden of making difficult decisions during emotionally charged moments.
Sample - North Carolina Do Not Resuscitate Order Form
North Carolina Do Not Resuscitate Order
In accordance with the North Carolina Do Not Resuscitate (DNR) Order guidelines, this document serves as a directive for healthcare professionals not to perform cardiopulmonary resuscitation (CPR) on the undersigned individual in the event of cardiac or respiratory arrest.
This order is made under the advisement of a licensed healthcare provider and is in compliance with North Carolina state laws, specifically under the North Carolina Medical Orders for Scope of Treatment (MOST) form protocol.
Patient Information:
- Full Name: ___________________________
- Date of Birth: ________________________
- Address: ______________________________
- City: _________________________________
- State: North Carolina
- Zip Code: ____________________________
- Telephone Number: _____________________
Medical Provider Information:
- Provider's Name: ________________________
- Provider's Title: ________________________
- Provider's Address: _____________________
- City: _________________________________
- State: North Carolina
- Zip Code: _____________________________
- Telephone Number: ______________________
By signing this order, the undersigned patient or their legally authorized representative acknowledges the decision to forego cardiopulmonary resuscitation (CPR) in circumstances of cardiac or respiratory arrest. It is understood that this does not prevent receiving other medical treatments deemed necessary for comfort and care.
This order is effective immediately upon signature and remains in effect until revoked or a new order is signed.
Patient or Legally Authorized Representative Signature:
Signature: ______________________________ Date: _______________
Witness Signature (if applicable):
Signature: ______________________________ Date: _______________
Healthcare Provider's Signature:
Signature: ______________________________ Date: _______________
Licensing Number: ________________________
This Do Not Resuscitate Order is duly executed in accordance with the laws of North Carolina and reflects the patient's wishes regarding resuscitation efforts.
File Specs
| Fact Name | Details |
|---|---|
| Definition | A Do Not Resuscitate (DNR) Order in North Carolina is a legal document that allows a person to refuse resuscitation in the event of cardiac or respiratory arrest. |
| Governing Law | The North Carolina Do Not Resuscitate Order is governed by N.C. Gen. Stat. § 90-321 through § 90-325. |
| Eligibility | Any adult, or a legally authorized representative of a minor or incapacitated person, can complete a DNR order in North Carolina. |
| Required Signatures | A valid DNR order must be signed by the patient or their representative and a physician to be effective. |
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