North Carolina's official portable Do Not Resuscitate order, adopted under N.C.G.S. 90-21.17, directs that CPR not be started if the patient has a cardiac or pulmonary arrest, and EMS honors it statewide. It does not affect other medically indicated or comfort care. Clinicians complete it for patients who have consented to a DNR outside the hospital, and the patient keeps it.
The attending physician, physician assistant or nurse practitioner completes the one-page form: the patient's name, effective date, any expiration date, and their signature, printed name and contact details. Signing attests that the basis for the order and the consent required by N.C.G.S. 90-21.17(b) are documented in the patient's record.
Download the current version from the source each time; forms change without notice.
Do Not Resuscitate Order
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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The signature line is for the attending physician, physician assistant or nurse practitioner. By signing, the clinician confirms that the basis for the order and the consent required by N.C.G.S. 90-21.17(b) are documented in the patient's records. The form also asks for an office and an emergency contact number.
Only if the clinician sets an expiration date. The form has an effective date, a line for an expiration date if any, and a box to check when there is no expiration. Complete one or the other, so EMS can see at a glance whether the order is still in effect.