Valid Do Not Resuscitate Order Template for South Carolina

A South Carolina Do Not Resuscitate (DNR) Order form is a legal document that allows individuals to express their wish not to receive cardiopulmonary resuscitation (CPR) in the event of cardiac arrest. This form ensures that medical personnel respect the patient's preferences regarding life-sustaining treatment. Understanding how to properly complete and implement this form is crucial for both patients and healthcare providers.

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The South Carolina Do Not Resuscitate (DNR) Order form is an important legal document that allows individuals to express their wishes regarding medical treatment in the event of a cardiac arrest or respiratory failure. This form is designed for patients who prefer not to receive cardiopulmonary resuscitation (CPR) or other life-sustaining measures. Completing the DNR Order ensures that healthcare providers understand and respect the patient's preferences during critical medical situations. The form requires the signature of the patient or their legal representative, as well as the signature of a physician, confirming that the decision is informed and voluntary. It is essential for individuals to discuss their choices with family members and healthcare professionals to ensure clarity and understanding. Additionally, the DNR Order must be readily available to emergency medical personnel and healthcare providers to ensure that the patient's wishes are honored in a timely manner. Understanding the implications of a DNR Order can help individuals make informed decisions about their end-of-life care, fostering a sense of control over their medical treatment preferences.

South Carolina Do Not Resuscitate Order Sample

South Carolina Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is based on the South Carolina Code of Laws and is intended to provide clear instructions regarding resuscitation efforts for the individual named below. This document must be completed in its entirety to be valid.

Patient Information:

Name: ____________________________________________
Date of Birth: _________________________________________
Address: ____________________________________________
City: ______________________ State: ______ Zip: ____________

Healthcare Provider Information:

Provider Name: ________________________________________
Provider Phone Number: __________________________________
Provider Address: ______________________________________

Patient's Wishes:

The patient, named above, hereby expresses the wish that in the event of cardiac or respiratory arrest, resuscitation efforts should not be initiated. This includes, but is not limited to, CPR, intubation, and any other measures to restore breathing or circulation.

Signature of Patient or Legal Guardian:

Signature: _____________________________________________
Date: _________________________________________________

Witness Information:

Witness Name: ________________________________________
Witness Signature: _____________________________________
Date: _________________________________________________

This order is valid until it is revoked by the patient or their authorized representative. A copy of this order should be provided to all relevant healthcare providers and kept in a prominent place for easy access.

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Key takeaways

Here are some key takeaways about filling out and using the South Carolina Do Not Resuscitate Order form:

Eligibility: The form is intended for individuals who have a terminal illness or are in a state of irreversible decline. It is crucial to assess the patient's condition before completing the form.
Completion: The form must be filled out accurately, including the patient's name, date of birth, and the signature of the physician. Ensure that all required fields are completed to avoid any issues.
Distribution: Once the form is signed, provide copies to all relevant parties, including family members, healthcare providers, and the hospital where the patient receives care. This ensures everyone is aware of the patient's wishes.
Revocation: The patient can revoke the Do Not Resuscitate Order at any time. It is important to communicate this decision to all parties who have a copy of the form.