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Homepage ➔ Fillable Do Not Resuscitate Order Form ➔ Attorney-Approved Do Not Resuscitate Order Document for the State of Virginia
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In Virginia, the Do Not Resuscitate (DNR) Order form plays a crucial role in guiding medical decisions for individuals who wish to forgo resuscitation in the event of a medical emergency. This form is designed to communicate a patient's preferences clearly to healthcare providers, ensuring that their wishes are respected during critical moments. It typically requires the signature of a physician, confirming that the patient is informed about their choices regarding life-sustaining treatments. The DNR Order must be easily accessible, often kept in a visible location or with a trusted family member, so that it can be presented in emergencies. Additionally, understanding the legal implications and the process for completing this form is essential for patients and families, as it empowers them to make informed decisions about end-of-life care. By discussing the key components and considerations surrounding the Virginia DNR Order form, individuals can better navigate this important aspect of healthcare planning.

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Dos and Don'ts

When completing the Virginia Do Not Resuscitate Order form, it is essential to follow specific guidelines to ensure that your wishes are clearly understood and legally recognized. Here are four key actions to take and avoid:

  • Do ensure that the form is filled out completely and accurately.
  • Do sign and date the form in the appropriate sections.
  • Don't use ambiguous language that could lead to misinterpretation of your wishes.
  • Don't forget to provide copies to your healthcare provider and family members.

Virginia Do Not Resuscitate Order Sample

Virginia Do Not Resuscitate Order Template

This Virginia Do Not Resuscitate (DNR) Order is a legal document that allows you to express your wishes regarding resuscitation efforts in the event of a medical emergency. It is essential to review this document with a healthcare professional to ensure it meets all legal requirements as outlined by Virginia state laws.

Patient Information

  • Patient's Full Name: ______________________________________
  • Date of Birth: ____________________________________________
  • Address: ________________________________________________
  • Emergency Contact Name: _________________________________
  • Emergency Contact Phone: ________________________________

Physician Information

  • Physician's Name: _________________________________________
  • Physician's Contact Information: _________________________

DNR Order Declaration

The patient named above declares that in the event of a medical emergency where resuscitation is needed, I do not wish for resuscitative measures to be performed. This includes procedures such as:

  • Cardiopulmonary resuscitation (CPR)
  • Assisted ventilation
  • Defibrillation

This decision is made based on my understanding of my medical condition and prognosis, and I confirm that I have considered the implications of this order.

Signatures

By signing below, I acknowledge that I understand and am making this choice voluntarily.

Patient's Signature: ________________________________ Date: ________________

Physician's Signature: ______________________________ Date: ________________

This document should be placed in your medical records and a copy should be provided to emergency medical personnel. Always keep this document easily accessible.

Listed Questions and Answers

  1. What is a Virginia Do Not Resuscitate Order (DNR)?

    A Virginia Do Not Resuscitate Order is a legal document that allows individuals to refuse resuscitation efforts in the event of cardiac arrest or respiratory failure. This order is intended for patients who wish to avoid aggressive medical interventions that may prolong dying rather than enhance quality of life.

  2. Who can complete a DNR order in Virginia?

    In Virginia, a DNR order can be completed by a patient who is at least 18 years old and is capable of making their own healthcare decisions. If the patient is unable to make decisions, a legally authorized representative, such as a family member or healthcare proxy, may complete the order on their behalf.

  3. How do I obtain a DNR order in Virginia?

    To obtain a DNR order, you must fill out the official Virginia DNR order form. This form is available from healthcare providers, hospitals, or online through the Virginia Department of Health website. Once completed, the form must be signed by the patient and a physician to be valid.

  4. What should I do with my DNR order once it is completed?

    After completing your DNR order, keep it in a safe but accessible place. It is crucial to share copies with your healthcare providers, family members, and anyone involved in your care. Ensure that your wishes are clearly communicated to avoid any confusion during a medical emergency.

PDF Characteristics

Fact Name Description
Definition A Do Not Resuscitate (DNR) Order is a legal document that informs medical personnel not to perform cardiopulmonary resuscitation (CPR) if a patient's heart stops or they stop breathing.
Governing Law The Virginia Do Not Resuscitate Order is governed by the Code of Virginia § 54.1-2987.1.
Eligibility Any adult who is capable of making their own medical decisions can complete a DNR Order.
Signature Requirement The DNR Order must be signed by the patient or their legal representative.
Medical Confirmation A physician must confirm the patient's medical condition before a DNR Order can be issued.
Validity The DNR Order remains valid until revoked by the patient or their representative.
Emergency Services Emergency medical personnel are required to honor the DNR Order if it is presented at the time of an emergency.
Form Availability The Virginia DNR Order form is available through healthcare providers and online resources.
Revocation Process A patient can revoke a DNR Order at any time, verbally or in writing, and this must be documented.
Additional Considerations It is recommended that patients discuss their DNR Order with family and healthcare providers to ensure understanding and compliance.