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Durable Do Not Resuscitate Order VIRGINIA DEPARTMENT OF HEALTH Patients Full Legal Name Date Physicians Order I, the undersigned, state that I have a bona fide physician/patient relationship with
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How to fill out durable do not resuscitate

01
Gather all necessary documents and forms for the durable do not resuscitate (DNR) order.
02
Ensure that the individual wishing to have a DNR order has the legal capacity to make healthcare decisions.
03
Discuss the decision with the individual's healthcare provider to understand the implications of a DNR order.
04
Fill out the DNR form accurately, including personal identification information.
05
Include clear and specific instructions regarding the desired resuscitation preferences.
06
Review the completed DNR form for accuracy and completeness.
07
Sign and date the DNR form, ensuring the signature follows any legal requirements.
08
Provide copies of the signed DNR form to the individual's healthcare provider, attorney, and family members.
09
Keep the original DNR form in a safe and easily accessible place, notifying key individuals of its location.

Who needs durable do not resuscitate?

01
Individuals with a terminal illness who wish to have their end-of-life wishes respected.
02
Elderly individuals who have discussed with their healthcare provider and made an informed decision against resuscitation.
03
Patients with serious medical conditions that may result in a poor quality of life even with successful resuscitation.
04
Individuals with advanced directives or living wills that include instructions for do not resuscitate orders.
05
Anyone who desires to have control over their end-of-life medical decisions and avoid unnecessary medical interventions against their wishes.
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A durable do not resuscitate (DNR) is a legal document that specifies a person's wish to not receive cardiopulmonary resuscitation (CPR) in case their heart stops or they stop breathing.
A durable do not resuscitate should be signed by the individual or their legal representative, and a physician must also sign it to make it valid.
To fill out a durable do not resuscitate, the individual or their legal representative must discuss their wishes with a physician, complete the form, and have it signed by both parties.
The purpose of a durable do not resuscitate is to ensure that a person's wishes regarding CPR are respected in case of a medical emergency.
A durable do not resuscitate must include the individual's name, date of birth, signature or legal representative's signature, physician's signature, and the date the form was signed.
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