Outline
In South Carolina, the Do Not Resuscitate (DNR) Order form serves as a crucial document for individuals who wish to express their preferences regarding medical interventions in the event of a cardiac or respiratory arrest. This form allows patients to communicate their desire not to receive cardiopulmonary resuscitation (CPR) or other life-saving measures, ensuring their wishes are respected during critical moments. It is essential for the form to be properly completed, signed, and witnessed to be valid, as healthcare providers rely on it to guide their actions in emergencies. The DNR Order must be readily accessible, often kept in a visible location or included in a patient’s medical records. Furthermore, understanding the implications of this decision can help families navigate difficult conversations about end-of-life care. Overall, the DNR Order is an important tool that empowers individuals to make informed choices about their medical treatment preferences while providing clarity for healthcare professionals.
Form Sample
South Carolina Do Not Resuscitate Order
This document serves as a directive in accordance with the South Carolina Do Not Resuscitate (DNR) Order guidelines. It indicates the wish of the individual named below, or their legally authorized representative, for no resuscitation attempts in the event of cardiac or respiratory arrest. This order is valid only within the state of South Carolina.
Patient Information
- Full Name: ___________________________
- Date of Birth: ___________________________
- Address: ___________________________
- City: ___________________________
- State: South Carolina
- Zip Code: ___________________________
Order
In accordance with the South Carolina Code of Laws, this order instructs that no resuscitative measures be taken to restore breathing or cardiac function in the event that my heart and/or breathing stops. This includes, but is not limited to, CPR (Cardiopulmonary Resuscitation), advanced airway management, and artificial ventilation.
Validity
This order is to remain in effect until it is revoked. It must be reviewed periodically, especially in the event of a significant change in the patient's medical condition.
Signature
By signing below, the patient (or their legally authorized representative) acknowledges they have discussed this order with their healthcare provider and understand its implications.
- Patient's Signature: ___________________________
- Date: ___________________________
- If signed by a legally authorized representative:
- Representative's Name: ___________________________
- Relationship to Patient: ___________________________
- Signature: ___________________________
- Date: ___________________________
Physician Information
A licensed physician must concur with the DNR order and sign below for it to be valid.
- Physician's Name: ___________________________
- License Number: ___________________________
- Address: ___________________________
- City: ___________________________
- State: South Carolina
- Zip Code: ___________________________
- Signature: ___________________________
- Date: ___________________________
Notice
This document does not prohibit the provision of life-sustaining treatment, including nourishment and hydration, except to the extent that such care would consist solely of resuscitation as defined above.
Form Attributes
| Fact Name | Description |
|---|---|
| Purpose | The South Carolina Do Not Resuscitate Order (DNR) form is designed to communicate a patient’s wish to forgo resuscitation efforts in the event of cardiac or respiratory arrest. |
| Governing Law | This form is governed by the South Carolina Code of Laws, specifically Title 44, Chapter 66, which addresses advance directives and medical orders. |
| Eligibility | Any adult who is capable of making healthcare decisions can complete a DNR order. This includes individuals with terminal illnesses or severe health conditions. |
| Signature Requirements | The DNR form must be signed by the patient or their legal representative. Additionally, a physician must sign to validate the order. |
| Form Accessibility | The DNR order form is available through healthcare providers, hospitals, and the South Carolina Department of Health and Environmental Control (DHEC). |
| Revocation | Patients have the right to revoke a DNR order at any time. This can be done verbally or in writing, and healthcare providers must honor the revocation. |
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