South Carolina Do Not Resuscitate (DNR) Order Form

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Updated May 31, 2022

The South Carolina do not resuscitate (DNR) order form is a notice informing emergency medical service providers that no resuscitative measures shall be administered to a patient in the event they experience cardiopulmonary arrest. A DNR order may be requested by the patient or from a representative authorized to make medical decisions on their behalf (i.e., surrogate or agent). Furthermore, the order may only be executed if a physician has determined that the patient suffers from a terminal condition.

South Carolina is developing the Physician Orders for Scope of Treatment (POST) program which enables patients to better outline their end-of-life health care decisions. Currently, the program is only available in Charleston and Greenville. Click here to learn more about the POST program.

Laws § 44-78-10 – § 44-78-65

Required to Sign – Physician, and patient (or surrogate/agent).

How to Write

Step 1 – Download the South Carolina DNR form in Adobe PDF.

Step 2 – Enter the patient’s name in the first available space.

Step 3 – Enter the following information in the spaces below the “REVOCATION PROCEDURE” heading:

  • Date of execution
  • Physician’s name
  • Physician’s address
  • Signature of patient/surrogate/agent
  • Physician’s signature
  • Physician’s telephone number