Free Do Not Resuscitate Order Template for North Carolina Make My Do Not Resuscitate Order Online

Free Do Not Resuscitate Order Template for North Carolina

A Do Not Resuscitate (DNR) Order form is a legal document that allows individuals to express their wishes regarding medical treatment in the event of a cardiac arrest or respiratory failure. In North Carolina, this form ensures that a person’s preference for not receiving resuscitation efforts is respected by healthcare providers. Understanding the implications and procedures surrounding the DNR Order can empower individuals to make informed decisions about their end-of-life care.

Form Sample

North Carolina Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is prepared in accordance with the North Carolina General Statutes. It is intended to communicate the wishes of the individual regarding resuscitation efforts in the event of a medical emergency.

Patient Information:

  • Full Name: _______________________________
  • Date of Birth: _____________________________
  • Address: ___________________________________
  • City: _____________________________________
  • State: NC
  • Zip Code: _________________________________

Healthcare Provider Information:

  • Provider Name: _______________________________
  • Provider Phone Number: ______________________

Patient's Statement:

I, the undersigned, hereby request that in the event of my cardiac arrest or respiratory failure, resuscitative measures not be initiated or, if begun, be discontinued. I understand the implications of this decision and make it willingly and without coercion.

Signature of Patient or Legal Representative:

  • Signature: _________________________________
  • Date: ____________________________________

Witness Information:

  • Witness Name: ______________________________
  • Witness Signature: _________________________
  • Date: ____________________________________

This DNR Order is effective immediately upon signing, provided that it is consistent with North Carolina law.

It is recommended that copies of this order be kept on file with the patient’s healthcare provider and in their personal medical records.

Misconceptions

  • Misconception 1: A DNR order means that a person will not receive any medical care.

    • This is incorrect. A Do Not Resuscitate (DNR) order specifically addresses resuscitation efforts in the event of cardiac arrest. It does not prevent other medical treatments or care from being provided.

  • Misconception 2: A DNR order is only for terminally ill patients.

    • A DNR can be requested by anyone who does not wish to receive resuscitation, regardless of their health status. It is not limited to those who are terminally ill.

  • Misconception 3: A DNR order is permanent and cannot be changed.

    • Patients can change or revoke their DNR orders at any time. It is important to communicate any changes to healthcare providers.

  • Misconception 4: A DNR order is the same as a living will.

    • A DNR order specifically addresses resuscitation efforts, while a living will outlines broader healthcare preferences. They serve different purposes.

  • Misconception 5: DNR orders are only valid in hospitals.

    • DNR orders can be valid in various settings, including homes, nursing facilities, and hospitals. However, it is essential to ensure that the order is recognized in each location.

  • Misconception 6: A DNR order means giving up on life.

    • Choosing a DNR order is a personal decision that reflects a person's values and wishes regarding end-of-life care. It does not signify a lack of will to live.

  • Misconception 7: Only doctors can initiate a DNR order.

    • Patients or their legal representatives can request a DNR order. Healthcare providers can assist in the process, but the decision ultimately lies with the patient or their advocate.

  • Misconception 8: A DNR order is automatically included in advance care planning.

    • A DNR order must be specifically requested and documented. It is not automatically included in general advance care planning documents.

  • Misconception 9: Family members can override a DNR order.

    • Once a DNR order is in place, family members cannot override it unless they have legal authority to do so. It is crucial for family members to respect the patient's wishes.

  • Misconception 10: DNR orders are only for older adults.

    • People of all ages can have DNR orders. It is a decision based on personal preferences and health considerations, not solely age.

Key takeaways

When considering the North Carolina Do Not Resuscitate (DNR) Order form, there are several important points to keep in mind. Understanding these can help ensure that your wishes regarding medical treatment are respected.

  1. Eligibility: The DNR order is intended for individuals with a terminal condition, serious illness, or those who are nearing the end of life. It is crucial to assess whether this form aligns with your health situation.
  2. Completion: The form must be filled out accurately and signed by the patient or their legal representative. It requires the signatures of both the patient and a physician to be valid.
  3. Communication: Once completed, it is essential to share the DNR order with family members, caregivers, and medical professionals. This ensures that everyone involved in your care is aware of your wishes.
  4. Legal Status: The DNR order is legally recognized in North Carolina, meaning that emergency medical personnel are required to honor it. However, it must be readily accessible in case of an emergency.
  5. Review and Update: Regularly review your DNR order, especially if your health status changes. Updating the form ensures that it reflects your current wishes and medical condition.

By understanding these key aspects of the North Carolina DNR order, individuals can make informed decisions about their end-of-life care preferences.

More Do Not Resuscitate Order State Forms

What Does Dnr Mean - Informed consent is key; make sure you understand what a DNR order entails before signing.

What Does Do Not Resuscitate Mean - A DNR does not prevent you from receiving other types of medical care.

Polst Form Wa - Once signed, a DNR order must be included in a patient’s medical records to be valid and effective.

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Can You Have a Dnr at Any Age - This order can be revoked at any time by the patient or their appointed decision-maker.