Printable Do Not Resuscitate Form Virginia 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
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 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
Printable Do Not Resuscitate Form Virginia
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Code of Virginia 54 1 2982 Durable Do Not Resuscitate Order means a written physician s order issued to withhold cardiopulmonary resuscitation from a particular patient in the event of cardiac or respiratory arrest What Can An EMS Provider Honor Virginia Durable Do Not Resuscitate DNR Orders Other DNR Orders The following words Do Not Resuscitate The patient s full legal name The physician s name and phone number and The Virginia Durable DNR issuance date Revocation
The revised DDNR form can be printed on any color paper white paper printed on a color printer is the recommended Health care providers may honor a legible copy of any of the three paged revised DDNR form The patient copy medical record copy or DDNR jewelry copy all may be honored Print PDF email FORMS 12VAC5 66 Durable Do Not Resuscitate Order Virginia Department of Health EMS 7105 eff 6 11 Website addresses provided in the Virginia Administrative Code to documents incorporated by reference are for the reader s convenience only may not necessarily be active or current and should not be relied upon
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Durable Do Not Resuscitate Order means written physician s order issued to withhold cardiopulmonary resuscitation from a particular patient in the event of cardiac or respiratory arrest What Can An EMS Provider Honor Virginia Durable Do Not Resuscitate DNR Orders Other DNR Orders Approved DDNR bracelets or necklaces Virginia Administrative Code Durable Do Not Resuscitate Orders 12VAC5 31 66 12VAC5 66 80 DDNR Order Implementation Procedure Resuscitative measures to be withheld or withdrawn Cardiac Compression Artificial Ventilation Defibrillation Endotracheal Intubation or other advanced airway management that pass beyond the oral pharynx Administrati
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 In accordance with this section and regulations promulgated by the Board of Health i qualified emergency medical services personnel as defined in 32 1 111 1 ii licensed health care practitioners in any facility program or organization operated or licensed by the Board of Health the Department of Social Services or the Department of Be
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https://www.vdh.virginia.gov/emergency-medical-services/other-ems-programs-and-links/durable-do-not-resuscitate-program/
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
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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Printable Do Not Resuscitate Form Virginia - 3 Durable DNR Order Form A Durable DNR Order or Alternate Durable DNR jewelry that complies with 12VAC5 66 50 shall be valid for the purposes of withholding or withdrawing cardiopulmonary resuscitation by qualified health care personnel in the event of cardiac or respiratory arrest 4 Availability of the Durable DNR Order Form
