N.D. Cent. Code ch. 23-06.5 · North Dakota
North Dakota: how to sign your advance directive
North Dakota has one health care directive, and it may contain instructions, an agent, or both — the statute does not make you choose. The form is optional; the state says so directly: "optional … not a required form."
Why WearableDocs
In North Dakota, the provider has to know the directive exists
Duty turns on knowledge, not on paper changing hands. WearableDocs is how they know: scan the card, open the page, read the document you signed — in the seconds someone is already asking for it.
You answer a few questions — your name, your state, and what you refuse — and WearableDocs builds the directive. Print it, sign it, upload it. Changing your answers later is part of the plan, so nothing is locked in.
What North Dakota asks
What you need to sign in North Dakota
- Instruments
- One health care directive, containing instructions, an agent, or both
- Form
- Illustrative — "optional … not a required form"
- Execution
- Two witnesses OR a notary
- May not witness
- Your agent, spouse, heir, any relative, an estate claimant, a creditor, whoever is financially responsible for you, and your attending physician — **all barred as witness or as notary. One of two witnesses may** be a direct-care provider
- May not be your agent
- A provider; a non-relative employee of one; a long-term care provider or its non-relative employee. The bar is capacity-based
- Copy rule
- Copy equals original — the strongest form found (§23-06.5-13(8))
- Delivery
- Not physical delivery — but the provider must know. §23-06.5-09(1) triggers the provider's duty on "having knowledge" of the directive rather than on receiving a copy. The copy rule means the document is not waiting on paper to operate
- Registry
- None
- Age
- 18
- Prehospital limit
- §23-06.5-13(13) — withholding directives do not apply to emergency treatment in a prehospital situation
- Carried device
- Nothing for the directive — and see below
- Citation
- N.D. Cent. Code ch. 23-06.5
Read from the enacted statute, 2026-09-18.
The instrument
What North Dakota actually recognizes
The chapter is also newer than most of the paper citing it. The former ch. 23-06.4 was recodified into ch. 23-06.5, effective 1 August 2005. Forms and guides that still cite 23-06.4 are citing a chapter that no longer exists.
North Dakota then does two things almost no other state does, and they pull in opposite directions — which is why this page has to be read to the end.
It has the strongest copy-equivalence rule in the country (§23-06.5-13(8)): a copy stands in for the original more completely than anywhere else in the fifty-one.
And it switches your directive off in an ambulance (§23-06.5-13(13)): withholding directives "do not apply to emergency treatment performed in a prehospital situation."
What the popular guides get wrong
Corrections for North Dakota
"Cite chapter 23-06.4." Recodified into 23-06.5, effective 1 August 2005. A North Dakota form citing 23-06.4 is citing a chapter that has not existed for two decades.
Carried on you
What a WearableDocs card does in North Dakota
North Dakota is one of two states in this set where carrying the document can work against you, and the page has to say so without flinching.
Withholding directives "do not apply to emergency treatment performed in a prehospital situation." (§23-06.5-13(13))
Read that as a North Dakota paramedic would. Your directive — instructing that treatment be withheld — does not apply in the prehospital setting. It is not that EMS might override it. The statute removes it from the field entirely.
So the claim that a carried directive speaks for you in an emergency is not merely unsupported in North Dakota. It is inverted. A page that implied otherwise would be telling a North Dakotan the opposite of what the statute says, at the moment it matters most.
What is still true, and what this page may say: North Dakota has the strongest copy-equivalence rule in the country, so once you are inside the system, a copy does everything the original does — and getting a copy into the record early is the whole benefit. The card is a record-building tool here, not a field tool. It gets the directive into the hands that will need it once the prehospital window has closed.
Two different instruments, two different rules, one page. That distinction is the most important thing on it.