North Carolina DNR Form: How Portable Do Not Resuscitate Orders Work

A living will sits in a file cabinet. A DNR order stops paramedics from performing CPR in your living room. In North Carolina, these are completely different documents — and confusing them is one of the most common (and most dangerous) mistakes families make.

If you or a loved one has a terminal illness and wants to avoid aggressive resuscitation at home, you need a portable DNR order — not just a living will. Here's exactly how it works in North Carolina.

DNR vs Living Will: The Critical Difference

A living will is an advance planning document you sign while healthy and competent. It tells future doctors to withhold life-prolonging treatment if you develop a terminal condition, enter permanent unconsciousness, or reach end-stage dementia. Hospitals check for it during an admission. Paramedics on a 911 call do not.

A portable DNR is a medical order signed by your physician (or PA or NP) based on your current medical condition. It tells EMS personnel: do not attempt cardiopulmonary resuscitation. It travels with the patient — hence "portable."

The legal authority for both comes from N.C.G.S. § 90-21.17, but they serve different roles at different moments.

The Goldenrod Paper Requirement

North Carolina enforces strict color-coding for emergency medical orders so that first responders can identify them instantly:

• Portable DNR orders must be printed on Goldenrod (deep yellow) paper
• MOST forms (Medical Orders for Scope of Treatment) must be printed on Astrobrights Pulsar Pink paper

A DNR printed on white paper may not be recognized by paramedics in an emergency. The color is the visual signal that tells EMS to check the document before starting resuscitation.

How to Get a Portable DNR in North Carolina

You cannot create a DNR order yourself. The process requires a licensed clinician:

1. Talk to your physician. Discuss your diagnosis, prognosis, and wishes regarding resuscitation. The conversation should include what DNR does and does not cover.

2. The physician signs the order. Your attending physician, physician assistant, or nurse practitioner completes and signs the official NC portable DNR form. This is a medical order, not a patient preference form.

3. Print on Goldenrod paper. The form must be printed on Goldenrod-colored paper. Your physician's office should handle this, but verify — some offices print on white paper by default.

4. Keep the original accessible. Post the original form where EMS can find it: on the refrigerator door, above the bed, on the bedroom door, or in a clear plastic sleeve near the front entrance. Do not lock it in a safe or filing cabinet.

What EMS Does When They Arrive

When paramedics respond to a 911 call, their default protocol is to begin CPR and advanced life support immediately. They look for a valid portable DNR before starting — but they need to find it fast.

If a valid DNR on Goldenrod paper is visible and properly signed, EMS will withhold CPR and resuscitation efforts. They will still provide comfort measures and contact the attending physician.

If they cannot locate a DNR, or if the form is on white paper, unsigned, or expired, they will begin resuscitation. Family members saying "they didn't want this" is not sufficient to override EMS protocol.

DNR vs MOST: When You Need More Than a DNR

A portable DNR addresses one question: should CPR be attempted? The MOST form (Medical Orders for Scope of Treatment) covers a broader range of treatment decisions:

• CPR preferences
• Level of medical intervention (comfort only, limited, or full treatment)
• Antibiotic use
• Artificial nutrition and hydration
• Whether to transfer to a hospital

For patients with serious chronic conditions, a MOST form printed on Astrobrights Pulsar Pink paper provides more comprehensive clinical guidance than a DNR alone. Both are physician-signed medical orders — the MOST simply covers more ground.

A completed MOST form can legally override conflicting instructions in a previously executed living will or Health Care Power of Attorney, because it represents the most current physician orders based on the patient's actual condition.

Can a DNR Be Revoked?

Yes. A competent patient can revoke a DNR at any time by telling their physician or by physically destroying the Goldenrod form. Family members cannot revoke a patient's DNR unless the patient lacks capacity and the healthcare agent (named in a Health Care Power of Attorney) makes that decision.

Putting the Pieces Together

A complete North Carolina advance care plan typically includes three layers:

1. Health Care Power of Attorney — names someone to make decisions if you can't
2. Living Will — documents your end-of-life treatment preferences
3. Portable DNR and/or MOST — translates those preferences into real-time medical orders

The first two are planning documents you complete while healthy. The third is a clinical order you obtain when a serious diagnosis makes it medically appropriate.

The North Carolina Advance Directive & Living Will Kit covers the planning side — the Health Care Power of Attorney and living will, with instructions on when and how to discuss DNR and MOST orders with your physician.

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