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In North Carolina, the Do Not Resuscitate (DNR) Order form serves as a critical tool for individuals who wish to communicate their preferences regarding medical treatment in the event of a life-threatening situation. This legally binding document allows patients to refuse cardiopulmonary resuscitation (CPR) and other life-sustaining measures when their heart stops or they stop breathing. It is essential for ensuring that a person's wishes are respected, particularly in emergency medical scenarios. The DNR form must be completed and signed by a physician, reflecting the patient's informed consent. Additionally, it is important for individuals to discuss their decision with family members and healthcare providers to ensure everyone understands the implications. The form should be readily accessible, often kept in a visible location, such as on the refrigerator or with other important medical documents. Understanding the nuances of this form can empower individuals to make informed choices about their end-of-life care, ensuring that their values and preferences guide medical decisions when they are unable to speak for themselves.

Documents used along the form

The North Carolina Do Not Resuscitate (DNR) Order form is a critical document for individuals who wish to refuse resuscitation in the event of cardiac or respiratory arrest. Along with this form, several other documents may be relevant to ensure that a person's healthcare wishes are respected. Below is a list of additional forms and documents commonly used in conjunction with the DNR Order.

  • Advance Directive: This document outlines a person's healthcare preferences, including decisions about medical treatments and end-of-life care. It can provide guidance for healthcare providers when the individual is unable to communicate their wishes.
  • Health Care Power of Attorney: This legal document allows an individual to appoint someone to make medical decisions on their behalf if they become incapacitated. It is essential for ensuring that a trusted person can advocate for the individual's healthcare preferences.
  • Living Will: A living will specifies what medical treatments a person does or does not want in situations where they are terminally ill or permanently unconscious. It complements the DNR Order by providing additional clarity on treatment preferences.
  • Physician Orders for Scope of Treatment (POST): This form details a patient's treatment preferences and is signed by a physician. It is designed for individuals with serious health conditions and ensures that their wishes are followed in various medical situations.
  • Patient Identification Card: This card serves as a quick reference for medical personnel to identify a patient's DNR status. It is often carried by the patient or their family members to ensure immediate access to important information.
  • California Civil form: To properly initiate a civil case in California, ensure you have the necessary documents, including the Civil Case Cover Sheet (CM-010), which can be found at califroniatemplates.com/.
  • Do Not Hospitalize Order: This document expresses a patient's wish to avoid hospitalization under certain circumstances, particularly when it conflicts with their end-of-life care preferences. It can be used alongside the DNR Order for clarity.
  • Emergency Medical Services (EMS) Protocols: These protocols provide guidance to EMS personnel regarding the treatment of patients with DNR orders. Understanding these protocols is crucial for ensuring that emergency responders respect the patient's wishes.
  • Medication Orders: This document outlines specific medications a patient wishes to receive or avoid. It can be important for managing pain and other symptoms in accordance with the patient's preferences, especially in end-of-life care.

Understanding these documents and their purposes can significantly enhance the ability to communicate healthcare wishes effectively. Each form plays a vital role in ensuring that an individual's preferences are honored throughout their medical care journey.

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North Carolina Do Not Resuscitate Order Example

North Carolina Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is executed in accordance with the North Carolina General Statutes, specifically under the guidelines provided in Chapter 90, Article 3, Part 4. It indicates the preference of the individual regarding resuscitation efforts in the event of a medical emergency.

Patient Information

  • Name: _____________________________
  • Date of Birth: _____________________________
  • Address: _____________________________

Orders by the Patient

I, the undersigned, do hereby state my wishes regarding resuscitation efforts:

  • In the event of respiratory or cardiac arrest, I do not wish to receive resuscitation efforts.
  • I understand that this order will prevent health care providers from initiating cardiopulmonary resuscitation (CPR) or other resuscitative measures.

Patient Signature

By signing below, I affirm that this order reflects my wishes:

  • Signature of Patient: _____________________________
  • Date: _____________________________

Witness Information

This order must be witnessed by an individual who is not a family member of the patient:

  • Name of Witness: _____________________________
  • Signature of Witness: _____________________________
  • Date: _____________________________

This Do Not Resuscitate Order should be placed prominently within the patient’s medical file and should be honored by all medical personnel in accordance with North Carolina law.

FAQ

What is a Do Not Resuscitate (DNR) Order in North Carolina?

A Do Not Resuscitate (DNR) Order is a legal document that allows a person to refuse resuscitation efforts in the event of a medical emergency where their heart stops beating or they stop breathing. In North Carolina, this order must be completed and signed by a physician and the patient or their legal representative. It ensures that medical personnel understand the patient’s wishes regarding life-saving interventions.

Who can request a DNR Order?

Any adult who is capable of making their own healthcare decisions can request a DNR Order. Additionally, a legal guardian or an individual holding a power of attorney for healthcare decisions can also initiate this request on behalf of someone who is unable to do so. It is important to have open discussions with healthcare providers and family members when considering a DNR Order.

How do I obtain a DNR Order in North Carolina?

To obtain a DNR Order, follow these steps:

  1. Schedule an appointment with your healthcare provider to discuss your wishes regarding resuscitation.
  2. If you decide that a DNR Order is right for you, your physician will complete the necessary form.
  3. Make sure to sign the form, along with your physician, and keep a copy for your records.
  4. It’s advisable to inform family members and caregivers about your DNR Order to ensure everyone is aware of your wishes.

What should I do with the DNR Order once I have it?

Once you have completed the DNR Order, it is crucial to keep it in a place where it can be easily accessed by medical personnel, such as:

  • Your medical records at your healthcare provider’s office.
  • With your personal medical information at home.
  • In a visible location, like on your refrigerator or with your emergency contacts.

Additionally, consider carrying a wallet card that indicates you have a DNR Order. This can help ensure that your wishes are respected in an emergency situation.

Key takeaways

Filling out and using the North Carolina Do Not Resuscitate Order (DNR) form is an important decision for individuals and their families. Here are some key takeaways to consider:

  • The DNR form must be signed by a licensed physician to be valid.
  • It is crucial to discuss your wishes with your healthcare provider and loved ones before completing the form.
  • The form should be kept in an easily accessible location, such as with other important medical documents.
  • Patients can revoke or modify the DNR order at any time, as long as they are competent to make decisions.
  • Emergency medical personnel are required to follow the DNR order when it is presented in a medical emergency.
  • Understanding the implications of a DNR order is essential; it does not affect other treatments, such as pain management or comfort care.

PDF Form Breakdown

Fact Name Details
Definition A Do Not Resuscitate (DNR) Order is a legal document that instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) if a person's heart stops or if they stop breathing.
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 Any adult can create a DNR order, provided they are capable of making their own medical decisions. This includes individuals with terminal illnesses or severe health conditions.
Form Requirements The DNR order must be signed by a physician and the patient or their legal representative. It must also be printed on a specific form that is recognized by healthcare providers.
Revocation A DNR order can be revoked at any time by the patient or their legal representative. This can be done verbally or by destroying the written document.
Healthcare Provider Responsibility Healthcare providers are required to honor a valid DNR order. They must verify the order and ensure that it is properly documented in the patient's medical record.