{"ref":"NC-HH-PR-02","title":"Advance Directives, Portable Do-Not-Resuscitate Orders, and MOST","category":"Client rights","summary":"Gives every adult patient written information about the right to accept or refuse treatment and to make advance directives under North Carolina law, before care is provided; records in a prominent place whether the patient has an advance directive; puts that information in the plan of care; never conditions care on whether a patient has one; and tells staff how to act on a valid portable do-not-resuscitate order or Medical Orders for Scope of Treatment (MOST) form in an emergency.","inShort":["Before care starts, give every adult patient the advance directive information sheet and ask if he or she has a living will, health care power of attorney, DNR order or MOST form.","Write the answer on the face sheet and ask for a copy for the record.","Care never depends on whether the patient has an advance directive.","In an emergency, call 911. Do not start CPR only if a valid portable DNR or MOST form says no CPR; otherwise start CPR if you are trained.","Do not witness or notarize a patient’s advance directive, and do not give legal advice."],"primaryCitation":"42 CFR §489.102","citations":["G.S. 90-320","G.S. 32A-15","G.S. 90-21.17","NC Medicaid Clinical Coverage Policy 3A"],"federalCitations":["42 CFR §489.100","42 CFR §489.102","42 CFR §484.60(a)(2)","42 CFR §484.50(c)(4)"],"surveyorAsks":["Show me where this patient was given advance directive information, and when, relative to the first visit of care.","Where in the record do you document whether the patient has an advance directive?"],"forms":[{"ref":"NC-HH-PR-02-A","title":"Advance Directive Information and Acknowledgment"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (42 CFR §489.102)","5. Written Information Given to Each Adult Patient","6. Patients Who Cannot Receive the Information at Admission","7. Documentation and the Plan of Care","8. Emergencies: Portable DNR Orders and MOST Forms","9. Witnessing and Notarizing","10. Conscience","11. Staff and Community Education; Changes in North Carolina Law","12. Responsibilities","13. Records and Compliance Monitoring","14. Staff Training","15. References","16. Related Policies and Forms","17. Approval","18. Revision History"],"version":"1.0","sample":false,"pack":"nc-hha","state":"North Carolina","service":"Home health","guides":[{"path":"/guides/home-health-agency-policies/","h1":"What policies and procedures are required for home health agencies?"},{"path":"/guides/home-health-conditions-of-participation/","h1":"Home health Conditions of Participation: which policies each one needs"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}