Fillable Do Not Resuscitate Order Template for the State of North Carolina

Fillable Do Not Resuscitate Order Template for the State of North Carolina

A North Carolina Do Not Resuscitate (DNR) Order form is a legal document that allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. This form is crucial for ensuring that a person's preferences about life-sustaining treatments are respected when they are unable to communicate. Understanding how to properly complete this form is essential for anyone considering their end-of-life care options.

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In North Carolina, the Do Not Resuscitate (DNR) Order form plays a crucial role in ensuring that individuals can express their wishes regarding medical interventions at the end of life. This legally binding document allows patients to indicate their desire not to receive cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest. It is particularly important for those with terminal illnesses or advanced medical conditions who wish to avoid aggressive life-saving measures that may not align with their personal values or quality of life preferences. The form must be completed and signed by both the patient and a physician, ensuring that the decision is informed and respected by medical personnel. Additionally, the DNR Order must be readily accessible, as emergency responders rely on it to guide their actions during critical situations. Understanding the nuances of this form can empower individuals and families to make informed decisions about end-of-life care, fostering conversations that honor personal choices and dignity in the face of serious health challenges.

Your Questions, Answered

  1. What is a Do Not Resuscitate (DNR) Order?

    A Do Not Resuscitate Order is a legal document that allows individuals to refuse certain medical treatments, specifically cardiopulmonary resuscitation (CPR), in the event of a medical emergency. This order is important for those who wish to avoid aggressive life-saving measures when they are near the end of life or have a terminal illness.

  2. Who can complete a DNR Order in North Carolina?

    In North Carolina, a DNR Order can be completed by a qualified physician. The individual for whom the order is being created must also be involved in the process. This includes adults who are capable of making their own medical decisions. For minors, a parent or legal guardian must consent to the DNR Order.

  3. How does one obtain a DNR Order form?

    The DNR Order form can be obtained through various healthcare providers, hospitals, or online resources from the North Carolina Department of Health and Human Services. It is important to ensure that the form is the official state version to ensure its validity.

  4. What information is required on the DNR Order form?

    The DNR Order form typically requires the following information: the patient's name, date of birth, a statement of the individual's wishes regarding resuscitation, and the signature of a physician. Additionally, the form may need to be signed by the patient or their legal representative.

  5. Is a DNR Order legally binding in North Carolina?

    Yes, a properly completed DNR Order is legally binding in North Carolina. Healthcare providers are required to honor the wishes outlined in the order. However, it is crucial that the form is filled out correctly and signed by the appropriate parties to ensure its enforcement.

  6. Can a DNR Order be revoked or changed?

    Yes, a DNR Order can be revoked or changed at any time. The individual who signed the order, or their legal representative, can communicate their wishes to healthcare providers. It is advisable to complete a new form if changes are made to ensure that the most current wishes are documented.

  7. Where should a DNR Order be kept?

    It is important to keep the DNR Order in a place where it can be easily accessed by healthcare providers. Many individuals choose to keep a copy in their medical records, with their primary care physician, or in a visible location in their home, such as on the refrigerator. Informing family members about the location of the document is also beneficial.

Detailed Guide for Using North Carolina Do Not Resuscitate Order

Completing the North Carolina Do Not Resuscitate Order form is an important step in ensuring that your healthcare preferences are respected in critical situations. This document allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. Below are the steps to fill out the form accurately.

  1. Obtain the North Carolina Do Not Resuscitate Order form. This can typically be found online or through healthcare providers.
  2. Read the instructions carefully. Familiarize yourself with the purpose of the form and the implications of your choices.
  3. Fill in your full name, date of birth, and any other identifying information requested on the form.
  4. Indicate your wishes regarding resuscitation by checking the appropriate box. Make sure to consider your healthcare preferences thoroughly.
  5. Provide the name and contact information of your healthcare provider, if applicable. This ensures that your wishes are communicated effectively.
  6. Sign and date the form. Your signature is essential as it validates your decisions.
  7. If applicable, have a witness sign the form. This step may be required to ensure the document's legitimacy.
  8. Make copies of the completed form. Keep one for your records and provide copies to your healthcare provider and family members.

Once you have completed these steps, ensure that the form is easily accessible to those who may need to refer to it. This proactive approach can help ensure your healthcare preferences are honored when it matters most.

Documents used along the form

The North Carolina Do Not Resuscitate Order (DNR) form is an important document for individuals who wish to express their preferences regarding resuscitation efforts in medical emergencies. Alongside the DNR, several other forms and documents may be relevant for ensuring that a person's healthcare wishes are honored. Below is a list of commonly used forms that complement the DNR order.

  • Advance Directive: This document outlines an individual's preferences for medical treatment in situations where they cannot communicate their wishes. It may include instructions on life-sustaining treatments and appoints a healthcare agent to make decisions on their behalf.
  • Healthcare Power of Attorney: This legal document designates a specific person to make medical decisions for someone if they become incapacitated. It is crucial for ensuring that an individual's healthcare preferences are respected.
  • Living Will: A living will specifies the types of medical treatment an individual wishes or does not wish to receive in the event of a terminal illness or irreversible condition. This document helps guide healthcare providers and family members during critical moments.
  • Physician Orders for Scope of Treatment (POST): This form provides specific medical orders regarding the level of care desired by a patient. It is particularly useful for those with serious illnesses, ensuring that their treatment preferences are clearly communicated to healthcare professionals.
  • Do Not Intubate (DNI) Order: This order specifies that a patient does not wish to be intubated in the event of respiratory failure. It can be used alongside a DNR to clarify preferences regarding breathing assistance.
  • Patient Advocate Designation: This document allows individuals to appoint someone to advocate for their healthcare preferences and rights. It can help ensure that a person's wishes are communicated effectively within the healthcare system.
  • Medical Records Release Form: This form authorizes the sharing of a patient’s medical records with designated individuals or organizations. It can be useful for ensuring that family members or caregivers have access to necessary health information.
  • Emergency Medical Services (EMS) Form: This form provides instructions for emergency responders regarding a patient's DNR status and other critical medical information. It helps ensure that first responders are aware of the patient's wishes in emergency situations.

Understanding these documents can help individuals and their families navigate healthcare decisions more effectively. It is advisable to review these forms regularly and discuss them with healthcare providers to ensure that they reflect current wishes and legal requirements.

Similar forms

The North Carolina Do Not Resuscitate (DNR) Order form shares similarities with the Advance Directive, which allows individuals to outline their healthcare preferences in the event they become unable to communicate. Both documents serve to ensure that a person’s wishes regarding medical treatment are respected, particularly in critical situations. While a DNR specifically addresses resuscitation efforts, an Advance Directive can cover a broader range of medical decisions, providing a more comprehensive view of a person's healthcare desires.

Another related document is the Physician Orders for Life-Sustaining Treatment (POLST). This form is designed for individuals with serious illnesses or advanced age, allowing them to specify their preferences for various medical treatments. Like the DNR, the POLST is a physician-signed document that is intended to guide healthcare providers in emergency situations. However, the POLST includes a wider array of treatment options beyond just resuscitation, making it a more detailed approach to end-of-life care.

The Living Will is another document that resembles the DNR Order. A Living Will allows individuals to express their wishes regarding life-sustaining treatment in situations where they are terminally ill or permanently unconscious. While both documents aim to prevent unwanted medical interventions, a Living Will typically encompasses a broader scope, addressing various types of life support, whereas the DNR specifically focuses on resuscitation efforts.

Health Care Power of Attorney (HCPOA) also bears similarities to the DNR Order. This document designates a trusted individual to make healthcare decisions on behalf of someone who is unable to do so. While a DNR provides specific instructions about resuscitation, the HCPOA empowers the appointed person to make decisions based on the patient’s overall wishes, which may include following a DNR order if that is part of the patient's preferences.

The Medical Order for Life-Sustaining Treatment (MOLST) is another document that closely aligns with the DNR Order. This form is similar to the POLST but is used in specific states and may have slight variations in terminology and format. Like the DNR, the MOLST is a medical order that must be signed by a healthcare provider, ensuring that the patient’s wishes regarding resuscitation and other life-sustaining treatments are honored in emergencies.

Do Not Intubate (DNI) orders are also akin to DNRs. A DNI order specifically instructs healthcare providers not to place a patient on a ventilator or provide artificial breathing support. While a DNR focuses on not performing cardiopulmonary resuscitation (CPR), a DNI addresses a different aspect of life-sustaining treatment, providing clarity on the patient's preferences regarding breathing assistance.

Another document is the Comfort Care Order, which emphasizes the importance of providing comfort rather than aggressive treatment. This order aligns with the philosophy of palliative care, focusing on alleviating suffering and enhancing quality of life. While a DNR may prevent resuscitation, a Comfort Care Order prioritizes the patient's comfort during their final days, ensuring that they receive compassionate care without unnecessary interventions.

In some cases, the Do Not Hospitalize (DNH) order can be compared to the DNR. This document is intended for patients who prefer to avoid hospitalization, particularly in end-of-life situations. Like a DNR, a DNH order reflects the patient’s wishes and can guide healthcare providers in making decisions that align with the individual’s desires for care, especially when it comes to avoiding potentially distressing hospital environments.

Finally, the End-of-Life Care Plan is another document that resonates with the DNR Order. This plan outlines an individual’s goals and preferences for care as they approach the end of life. It can include directives similar to those found in a DNR, ensuring that healthcare providers understand the patient’s wishes regarding resuscitation and other life-sustaining measures, while also addressing emotional and spiritual considerations during this critical time.

Document Overview

Fact Name Description
Definition A Do Not Resuscitate (DNR) Order in North Carolina is a medical order that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) in the event of a cardiac or respiratory arrest.
Governing Law The North Carolina Do Not Resuscitate Order is governed by North Carolina General Statutes, specifically N.C.G.S. § 90-321 through § 90-325.
Eligibility Individuals who are at least 18 years old and have a terminal illness or a condition that leads to a high likelihood of death may request a DNR Order.
Form Requirements The DNR Order must be signed by a physician and the patient or their legal representative. It should be printed on the official North Carolina DNR form to be recognized by healthcare providers.