Nova Scotia Green Sleeve

When Nova Scotia paramedics respond to a call at your home, they are trained to check one specific location before they do almost anything else: your refrigerator. They are looking for a green plastic folder — the Green Sleeve — that contains the documents they need to know whether you want aggressive medical intervention or comfort-focused care.

If the Green Sleeve is not there, or if it is empty, the paramedics default to full resuscitation and treatment. Your Personal Directive, even if it sits in a filing cabinet two rooms away, may not be found in time to change that.

What a Green Sleeve Is

The Green Sleeve is part of Nova Scotia Health's advance care planning system. It is a standardized green plastic folder designed to hold all of your critical healthcare planning documents in one place. The name is literal — it is green, and it acts as a sleeve for your paperwork.

The concept is simple: paramedics, hospital staff, and long-term care facilities all know to look for it. A Green Sleeve on the fridge is a signal that this patient has documented their wishes and that actionable medical orders are inside.

What Goes in the Green Sleeve

Your Green Sleeve should contain the following documents, in this order:

Goals of Care (GOC) form (CL-AS-005). This is the clinician-completed form that translates your treatment preferences into a formal medical order. It is completed by your Most Responsible Health Care Provider or an Authorized Prescriber after a clinical conversation about your care goals. The GOC form is the document that paramedics and emergency staff act on — it carries direct medical authority.

Note: Nova Scotia Health retired the old "Do Not Resuscitate" (DNR) and "Allow Natural Death" (AND) forms on July 23, 2024. These forms should no longer be used. If you have old DNR forms in your Green Sleeve, they should be replaced with a current Goals of Care form.

Your signed Personal Directive. This is your legal document naming your healthcare delegate and recording your treatment preferences. While paramedics primarily act on the GOC form, the Personal Directive provides the legal foundation that supports it and names the person authorized to make decisions on your behalf.

Expected Death at Home (EDAH) form (if applicable). If you have a life-limiting illness and plan to die at home, this form identifies your chosen funeral home and the physician or nurse practitioner who has agreed to complete the Medical Certificate of Death within 24 hours. When the EDAH form is in place, your family calls the funeral home directly after death — not 911. Without it, calling 911 triggers a police investigation and potential forensic autopsy, even if the death was expected.

EHS Special Patient Program care plan (if applicable). If you are enrolled in the Emergency Health Services Special Patient Program, your individualized care plan should be in the Green Sleeve so paramedics can follow it immediately.

How to Get a Green Sleeve

Green Sleeves are distributed by Nova Scotia Health through healthcare providers, hospitals, community health centres, and palliative care programs. Your family doctor, a hospital social worker, or a palliative care nurse can typically provide one.

If you cannot obtain one through a healthcare provider, ask how to obtain the standard folder. Using the standard green folder is strongly recommended because it is what paramedics are trained to recognize.

Where to Store the Green Sleeve

The standard instruction is to place the Green Sleeve on top of the refrigerator or on the front of the refrigerator using a strong magnet. The key is visibility and consistency — every Nova Scotia paramedic knows to check the fridge area.

Do not store your Green Sleeve in a bedroom drawer, a safety deposit box, a filing cabinet, or a home office. These locations make the documents functionally invisible during an emergency.

If you spend significant time at a second location — a cottage, a partner's home, a seasonal residence — consider preparing a second Green Sleeve for that location as well.

The Gap Between Legal Documents and Clinical Action

A Personal Directive is a legal instruction to your delegate. A Goals of Care form is a clinical order to your healthcare team. They serve different functions, and having one without the other creates a gap.

If you have a Personal Directive but no Goals of Care form, paramedics have no medical order to follow. They must default to full treatment.

If you have a Goals of Care form but no Personal Directive, the GOC form can still guide care, but the statutory hierarchy — not a person you chose in a Personal Directive — may determine who makes later personal-care decisions when your condition changes.

The Green Sleeve bridges this gap by housing both documents together, ensuring that the clinical order and the legal authority supporting it are both immediately accessible.

The Nova Scotia Advance Directive & Living Will Kit includes a Green Sleeve staging checklist, a Goals of Care conversation guide for your next physician appointment, and a document storage and access log to track where every copy of your directive is held.

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