Dnr Form For North Carolina

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State:
Multi-State
Control #:
US-02091BG
Format:
Word; 
Rich Text
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Description

A do not resuscitate (DNR) order is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. Unless given other instructions, hospital staff will try to help all patients whose heart has stopped or who have stopped breathing. A DNR order is put in your medical chart by your doctor. DNR orders are accepted by doctors and hospitals in all states.


This form is a generic example that may be referred to when preparing such a form for your particular state. It is for illustrative purposes only. Local laws should be consulted to determine any specific requirements for such a form in a particular jurisdiction.

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  • Preview Do Not Resuscitate Order - DNR or Advance Directive

How to fill out Do Not Resuscitate Order - DNR Or Advance Directive?

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FAQ

It may be recommended to the family that they present their case to the hospital's ethics committee. Ultimately, however, the decision to write a DNR order rests with the physician and the patient. Family disagreements and opinions unfortunately do not reverse a DNR order when the patient themself requested the DNR.

The event of cardiac or respiratory arrest. I understand that in the event of a cardiac or respiratory arrest, no cardiopulmonary resuscitation is to be undertaken. The above identified patient has expressed wishes to not have CPR in the event of cardiac or respiratory arrest.

The DNR must be signed by the patient or by the patient's legally recognized health care decision maker if the patient is unable to make or communicate informed health care decisions.

You can use an advance directive form or tell your doctor that you don't want to be resuscitated. Your doctor will put the DNR order in your medical chart. Doctors and hospitals in all states accept DNR orders. They do not have to be part of a living will or other advance directive.

How to Write a DNR Form Write the name of the patient and then state where you or that person lives. Make sure to make the requests known, that CPR, or another treatment, is to be withheld. Acknowledgement: The people who are in charge of the patient must sign the document.

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Dnr Form For North Carolina