Fillable Printable Virginia Do Not Resuscitate Form Step 1 Download the Virginia DNR order form in PDF Step 2 Proceed to the third page of the order form The first two 2 spaces at the top of page 3 must be filled in with the patient s full legal name and the date
Health care personnel commencing on the effective date noted above to withhold endotracheal intubation and other advanced airway management artificial from the patient in the event of the patient s cardiac or respiratory arrest I interventions such as intravenous fluids oxygen or other comfort care or alleviate pain Virginia Create Document Updated August 28 2023 A do not resuscitate DNR order is used for patients who do not want to be saved if their heart or breathing stops This is generally the case for individuals with late stages of cancer or other advanced medical issues
Fillable Printable Virginia Do Not Resuscitate Form
Fillable Printable Virginia Do Not Resuscitate Form
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The Durable Do Not Resuscitate DDNR Order and its regulations have been developed to carry out the intent of applicable Virginia law that provides a person the opportunity to execute a DDNR Order that comports with his her wishes Applicability Durable Do Not Resuscitate Order means a written physician s order issued pursuant to 54 1 2987 1 to withhold cardiopulmonary resuscitation from a particular patient in the event of cardiac or respiratory arrest
A do not resuscitate DNR order form is an order written by a physician to withhold lifesaving measures if a patient goes into cardiac or respiratory arrest Unless a patient has a DNR order on file healthcare personnel will begin cardiopulmonary resuscitation CPR when necessary Virginia Do Not Resuscitate Order DNR Form DNR stands for Do Not Resuscitate This document shows a patient s will to exercise their right to reject resuscitation and die a natural death due to an accident illness or old age When a person chooses to reject such medical help they need a legal document to make that possible
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Durable Do Not Resuscitate Order or Durable DNR Order means a written physician s order issued pursuant to 54 1 2987 1 of the Code of Virginia in a form or forms authorized by the board to withhold cardiopulmonary resuscitation from an individual in the event of cardiac or respiratory arrest Durable Do Not Resuscitate Orders 54 1 2987 1 Durable Do Not Resuscitate Orders A As used in this section Health care provider includes but is not limited to qualified emergency medical services personnel Person authorized to consent on the patient s behalf means any person authorized by law to consent on behalf of the patient
Create a free do not resuscitate DNR form to instruct healthcare professionals not to perform CPR in the event of a medical emergency Fill in your name and the state where you live Step 2 Sign and Date the Document Virginia Patient and Physician VA Code 54 1 2987 1 Washington Patient and 2 Witnesses Durable Do Not Resuscitate Order Virginia s Durable Do Not Resuscitate DDNR Order passed by the Virginia General Assembly allows qualified health care personnel to honor a patient s request for humane comfort measures while avoiding resuscitation in the event of cardiac or respiratory arrest Originally passed in 1992 and amended in 1994
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Step 1 Download the Virginia DNR order form in PDF Step 2 Proceed to the third page of the order form The first two 2 spaces at the top of page 3 must be filled in with the patient s full legal name and the date
https://ris.dls.virginia.gov/uploads/12VAC5/forms/22f9c002902~1.pdf
Health care personnel commencing on the effective date noted above to withhold endotracheal intubation and other advanced airway management artificial from the patient in the event of the patient s cardiac or respiratory arrest I interventions such as intravenous fluids oxygen or other comfort care or alleviate pain
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Fillable Printable Virginia Do Not Resuscitate Form - Durable Do Not Resuscitate Order means a written physician s order issued pursuant to 54 1 2987 1 to withhold cardiopulmonary resuscitation from a particular patient in the event of cardiac or respiratory arrest
