Get Durable Do Not Resuscitate Order - University Of Virginia - Virginia

Filling out the Durable Do Not Resuscitate Order is an important step in ensuring that your health care preferences are honored in critical situations. This guide provides clear, step-by-step instructions for completing the order online, making the process accessible and understandable for all users.

Follow the steps to successfully complete the Durable Do Not Resuscitate Order online.

1. Click ‘Get Form’ button to access the Durable Do Not Resuscitate Order form and open it in the editor.
2. Begin by entering the patient’s full legal name and the date at the top of the form.
3. In the physician's order section, ensure that you have a bona fide physician/patient relationship. The physician must confirm this relationship.
4. Indicate whether the patient is capable or incapable of making informed decisions by selecting either option 1 or 2. If checking option 1, the patient’s signature is required.
5. If option 2 is selected, check one of the sub-options (A, B, or C) to clarify the status of the patient’s advanced directive and sign where indicated.
6. Complete the instruction section directing health care personnel on withholding cardiopulmonary resuscitation in case of cardiac or respiratory arrest.
7. Have the physician complete their printed name, PIC number, and signature.
8. If applicable, ensure that the patient's signature or the signature of the person authorized to consent on the patient’s behalf is provided, along with an emergency phone number.
9. Review all entered information for accuracy before saving your changes. You may download, print, or share the completed form as necessary.

Take the necessary steps to complete your Durable Do Not Resuscitate Order online today.