NON-TRANSPORT VEHICLE (QRV) INSPECTION FORMS
AMBULANCE INSPECTION FORMS
- Convalescent Ambulance
- Emergency Medical Technician (EMT) Ambulance
- Advanced Emergency Medical Technician (AEMT) Ambulance
- Paramedic Ambulance
- Specialty Care Ground Ambulance
- Air Ambulance
SPECIALTY VEHICLE INSPECTION FORMS
Do Not Resuscitate (DNR) & Medical Orders for Scope of Treatment (MOST) Forms
DISCLAIMER: The attached forms are only for the use of physicians and other licensed healthcare facilities. Unauthorized downloading is strictly prohibited and may result in action being taken by the NC Office of EMS.
Pursuant to N.C. General Statute 90-21.17, the department, through the Office of Emergency Medical Services, has adopted an official portable Do Not Resuscitate (DNR) form and Medical Order for Scope of Treatment (MOST) form for use by physicians and other licensed healthcare facilities to assist in providing information relating to a patient’s desire for resuscitation or life-prolonging measures.
These forms are available only to physicians’ offices or other licensed hospital or healthcare facilities.
OEMS will no longer mail these forms to authorized physicians’ offices or other licensed hospital or healthcare facilities. These forms are now available for download and printing by authorized entities only.
DNR Forms must be printed on “Goldenrod” colored paper.
Most Forms must be printed on “Astrobrights Pulsar” (pink) colored paper.
For a copy of the portable DNR or MOST form:
Information about Advance Health Care Directives can be found on the Secretary of State’s website.
For questions please contact Paige Stevens at paige.stevens@dhhs.nc.gov
