This is a form initiated by a patient requesting that he/she not be resuscitated should he/she stop breathing or should his/her heart stop beating. This form is also to be signed by a physician attesting to patient's wishes and to be placed in the patient's file.
Virginia Do Not Resuscitate Request - DNR
State:
Multi-State
Control #:
US-PRM-12
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Word;
Rich Text
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How to fill out Do Not Resuscitate Request - DNR?
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FAQ
The most important factor to bear in mind is that the law does not require a patient, or their family to consent to a DNR order. This means a doctor can issue a DNR order, even if you do not want one (see section on what to do if there is a disagreement).
You decide deciding in advance to refuse CPR You can make it clear to your doctor or medical team that you do not want CPR if your heart or breathing stops. Your doctor may complete a DNACPR form to indicate this and put it in your medical records.
You can write an advance directive in several ways: Use a form provided by your doctor. Write your wishes down by yourself. Call your health department or state department on aging to get a form.
With a Durable DNR A Durable DNR (DDNR) is a written order by a doctor on a specific state-mandated form that is also signed by the patient or, if appropriate, the patient's surrogate decision-maker. DDNRs are effective across settings and time.
The most important factor to bear in mind is that the law does not require a patient, or their family to consent to a DNR order. This means a doctor can issue a DNR order, even if you do not want one (see section on what to do if there is a disagreement).
Use VA Form 10-0137 to give specific people permission to make health care decisions for you, and to let VA health care providers know your wishes for medical, mental health, long-term, and other types of care.
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.
When You are Unable to Make the Decision You may have named someone to speak for you, such as a health care agent. If so, this person or a legal guardian can agree to a DNR order for you.
How is a DNR Order Created?The doctor writes the DNR order in your medical record if you are in the hospital.Your doctor can tell you how to get a wallet card, bracelet, or other DNR documents to have at home or in non-hospital settings.Standard forms may be available from your state's Department of Health.
Do not resuscitate order A DNR is a request not to have CPR if your heart stops or if you stop breathing. You can use an advance directive form or tell your doctor that you don't want to be resuscitated. Your doctor will put the DNR order in your medical chart. Doctors and hospitals in all states accept DNR orders.
