Dnr Form Blank For Virginia

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Multi-State
Control #:
US-02091BG
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Word; 
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Description

A do not resuscitate (DNR) order is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. Unless given other instructions, hospital staff will try to help all patients whose heart has stopped or who have stopped breathing. A DNR order is put in your medical chart by your doctor. DNR orders are accepted by doctors and hospitals in all states.


This form is a generic example that may be referred to when preparing such a form for your particular state. It is for illustrative purposes only. Local laws should be consulted to determine any specific requirements for such a form in a particular jurisdiction.

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How to fill out Do Not Resuscitate Order - DNR Or Advance Directive?

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FAQ

Does a DNR need to be notarized in VA? Documents You Should be Aware of This document does not have to be notarized or witnessed and it does not have to be completed by an attorney.

Signing a DNR Order You can request to sign a do not resuscitate order if you are not incapacitated and do not have a current appointed guardian to make medical decisions on your behalf. Only you and your doctor will need to sign the form for it to become valid and enforceable.

A Durable DNR Order Form or Other DNR Order may be issued to a patient by a physician, with whom the patient has established a bona fide physician/patient relationship, only with the consent of the patient or, if the patient is a minor or is otherwise incapable of making an informed decision regarding consent for such ...

I, _________________________________________, request limited emergency care as herein described. I understand DNR means that if my heart stops beating or if I stop breathing, no medical procedure to restart breathing or heart functioning will be instituted.

A DNR order must be written by a doctor. The doctor will typically explain your options to you and your family, outlining what the DNR entails. With your consent, the doctor will create the order and enter it into your medical record. It will then be visible and applicable to any medical professionals who treat you.

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Dnr Form Blank For Virginia