Goals of Care Form Nova Scotia

Your mother has a signed Personal Directive. She does not want CPR. She does not want a ventilator. She wants comfort measures only. But when paramedics arrive at her home, they start CPR anyway. The directive is on the kitchen counter, but that does not matter — because she never completed a Goals of Care form.

This scenario is common in Nova Scotia, and it stems from a gap that most families do not realize exists until it is too late.

What the GOC Form Is

The Goals of Care and Levels of Intervention form (CL-AS-005) is a standardized Nova Scotia Health clinical document that translates a patient's treatment preferences into a formal medical order. Unlike a Personal Directive, which is a legal document written by the patient, the GOC form is a medical order completed and signed by a physician or nurse practitioner.

The distinction matters because paramedics and emergency staff are trained to follow medical orders, not to interpret legal documents. In the field, a GOC form is immediately actionable. A Personal Directive requires reading, interpretation, and judgment calls that emergency responders do not have time to make.

The Three Levels of Intervention

The GOC form establishes where the patient falls on a spectrum of care:

Full intervention. The patient wants every available treatment, including CPR, intubation, mechanical ventilation, and ICU admission. This is the default if no GOC form exists.

Modified intervention. The patient wants some treatments but has placed specific limits. For example, they may want IV antibiotics and hospital admission but not CPR or ventilator support. The form allows clinicians to document exactly which interventions are accepted and which are refused.

Comfort care. The patient wants symptom management, pain control, and dignity-preserving measures only. No life-prolonging treatments. This level is appropriate for patients who have decided that quality of remaining life takes priority over extending it.

How to Get a GOC Form Completed

The form is initiated through a clinical conversation — you cannot download and fill it out yourself.

Request the conversation. Ask your family doctor, specialist, or nurse practitioner for a Goals of Care discussion at your next appointment. If you or your family member is being admitted to a hospital or long-term care facility, the care team should initiate this conversation during the admission process.

Prepare for specifics. General statements do not work well on the GOC form. Come prepared to answer concrete questions: Do you want CPR? If your heart stops, do you want to be placed on a ventilator? Would you accept a feeding tube if you could not swallow? Do you want to be transferred to a hospital from a care home, or would you prefer to remain in place?

The clinician completes the form. After the discussion, the Most Responsible Health Care Provider or Authorized Prescriber fills out the GOC form, selects the appropriate level of intervention, documents any specific limitations, and signs it.

Faxing and filing. The clinician must fax both sides of the completed form to Nova Scotia Health at 902-473-4999 to update the central electronic record. A copy goes into the patient's medical chart, and another copy is placed inside the patient's Green Sleeve for home storage.

Validation Timelines

The GOC form must be validated within strict timeframes upon facility admission:

• 24 hours of acute care (hospital) admission
• 72 hours of long-term care admission

If the form is not validated within these windows, the patient's care defaults to full intervention regardless of their stated preferences. This means that even if a patient has a signed Personal Directive requesting comfort care, a hospital emergency before GOC validation will trigger full resuscitation.

Updating and Replacing the Form

A GOC form is not permanent. It should be updated whenever the patient's condition changes significantly, when treatment preferences evolve, or when the patient transfers between care settings (hospital to home, home to long-term care). Each update requires a new clinical conversation and a freshly completed form.

The old form should be removed from the Green Sleeve and replaced with the current one. Outdated forms left in the Green Sleeve create confusion and can lead to care that contradicts the patient's current wishes.

Where the GOC Form Fits in Your Planning

The GOC form is the clinical execution layer of your advance care plan. Your Personal Directive provides the legal authority and documents your values. Your GOC form tells the medical team exactly what to do. Your Green Sleeve keeps them both accessible in an emergency. Without all three, the plan has a gap.

The Nova Scotia Advance Directive & Living Will Kit includes a Goals of Care appointment card with preparation questions, sample language for each intervention level, and a Green Sleeve staging guide to ensure your GOC form and Personal Directive are both current and accessible.

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