Content Overview
Form Breakdown
| Fact Name | Description |
|---|---|
| Definition | A Do Not Resuscitate (DNR) Order is a legal document that instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest. |
| Governing Law | In North Carolina, DNR Orders are governed by N.C. Gen. Stat. § 90-321 through § 90-325. |
| Eligibility | Any adult who is capable of making their own healthcare decisions can create a DNR Order. |
| Signature Requirement | The DNR Order must be signed by the patient or their legal representative, along with a physician’s signature. |
| Form Availability | The North Carolina DNR Order form is available through healthcare providers, hospitals, and online resources. |
| Revocation | A DNR Order can be revoked at any time by the patient or their legal representative, verbally or in writing. |
| Emergency Services | Emergency medical personnel are required to honor a valid DNR Order when responding to a medical emergency. |
| Placement | It is advisable to keep the DNR Order in an easily accessible location, such as on the refrigerator or with the patient’s medical records. |
| Communication | Patients should discuss their DNR wishes with family members and healthcare providers to ensure everyone is informed. |
Sample - North Carolina Do Not Resuscitate Order Form
North Carolina Do Not Resuscitate Order Template
This Do Not Resuscitate (DNR) order is created in accordance with North Carolina state law regarding advance directives and resuscitation preferences. Please fill in the necessary information where indicated.
Patient Information
- Name: ____________________________________
- Date of Birth: ____________________________
- Medical Record Number: ___________________
Decision Maker (if applicable)
- Name: ____________________________________
- Relationship to Patient: ____________________
- Contact Information: ________________________
Order Statement
I, the undersigned, hereby declare my wishes regarding medical treatment as follows:
If at any time I am unable to communicate my wishes and my heart stops beating or I stop breathing, I do not want medical personnel to attempt resuscitation. This decision reflects my personal values and desires regarding end-of-life care.
Signatures
By signing below, I acknowledge that I understand the implications of this DNR order:
Patient Signature: ___________________________ Date: _____________
Decision Maker Signature (if applicable): ____________________ Date: _____________
Witness Signature: ____________________________ Date: _____________
Witness Signature: ____________________________ Date: _____________
Important Note
This Do Not Resuscitate order should be easily accessible, and copies should be provided to all healthcare providers involved in patient care. It is also advisable to have discussions regarding this order with family members and health care proxies.
Common mistakes
When filling out the North Carolina Do Not Resuscitate Order form, individuals often make several common mistakes that can lead to confusion or unintended consequences. One of the most frequent errors is failing to sign the form. Without a signature, the document is not valid. This oversight can result in healthcare providers not honoring the wishes of the individual regarding resuscitation.
Another mistake is not having the form witnessed correctly. The state of North Carolina requires that the form be signed in the presence of two witnesses. If this step is overlooked, the form may not be accepted by medical personnel. It’s crucial to ensure that the witnesses are not related to the individual or involved in their healthcare to maintain the integrity of the document.
People sometimes neglect to fill out the form completely. Leaving sections blank can create ambiguity about the individual's wishes. Every section should be filled out clearly to avoid any misinterpretation by healthcare providers. This includes specifying the individual’s preferences regarding resuscitation efforts.
Additionally, individuals may fail to communicate their wishes with family members or healthcare providers. Simply having the form is not enough; it should be discussed openly with loved ones and medical staff. This conversation helps ensure that everyone is on the same page and that the individual’s wishes are respected.
Another common error is not keeping the form accessible. It’s important to store the Do Not Resuscitate Order in a place where it can be easily found in an emergency. If the document is not readily available, it may not be honored when needed most. Consider keeping copies in multiple locations, such as with a healthcare provider and at home.
Lastly, individuals sometimes forget to update the form as their circumstances change. Life events, such as changes in health status or personal preferences, may necessitate a revision of the order. Regularly reviewing and updating the Do Not Resuscitate Order ensures that it accurately reflects the individual’s current wishes.
Discover More Do Not Resuscitate Order Templates for Specific States
Dnr Do Not Resuscitate - Requires understanding and careful consideration of personal values and beliefs.
Dnr Directive - Patients in long-term care facilities often utilize DNR orders as part of their care plan.
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