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Virginia Administrative Code
Title 12. Health
Agency 5. Department Of Health
Chapter 66. Regulations Governing Durable Do Not Resuscitate Orders
1/28/2022

12VAC5-66-40. The Durable Do Not Resuscitate Order Form.

The Durable DNR Order Form shall be a standardized document as approved by the board and consistent with these regulations. The following requirements and provisions shall apply to the approved Durable DNR Order Form.

1. Content of the Form - A Durable DNR Order Form shall contain, from a physician with whom the patient has a bona fide physician/patient relationship, a do not resuscitate determination, signature and the date of issue, the signature of the patient or, if applicable, the person authorized to consent on the patient's behalf.

2. Effective Period for a Signed Durable DNR Order - A signed Durable DNR Order shall remain valid until revoked in accordance with § 54.1-2987.1 of the Code of Virginia and 12VAC5-66-80 E or until rescinded, in accordance with accepted medical practice, by the provider who issued the Durable Do Not Resuscitate Order.

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. The Durable DNR Order Form that complies with this section or Alternate Durable DNR jewelry that complies with 12VAC5-66-50 shall be maintained and readily available to qualified health care personnel at the patient's current location or residence.

5. Qualified health care personnel may honor a legible photocopy of a Durable DNR Form or Other Durable DNR Order as if it were an original.

6. A patient who is traveling outside his home or between health care facilities should have an original or photocopied Durable DNR Order, Other Durable DNR Order, or Alternate Durable DNR jewelry accompany him.

7. Distribution of Durable DNR Order Forms - The authorized Virginia Durable DNR Order Form shall be a standardized form available for download via the Internet from the Office of Emergency Medical Services website. The downloadable form will contain directions for completing the form and three identical Durable DNR Order Forms: one original form to be kept by the patient, the second to be placed in the patient's permanent medical record, and the third to be used by the patient for requesting Alternate Durable DNR jewelry.

8. Hard copies of the Durable DNR Order Form shall also be made available to physicians or licensed health care facilities by the Office of EMS. The Office of EMS may utilize a vendor to print and distribute the Durable DNR Order Form and a nominal fee may be charged in an amount necessary to cover printing and shipping fees.

Statutory Authority

§§ 32.1-12 and 32.1-111.4 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 18, Issue 12, eff. March 27, 2002; amended, Virginia Register Volume 27, Issue 21, eff. July 20, 2011.

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