Chapter 66. Regulations Governing Durable Do Not Resuscitate Orders
12VAC5-66-10. Definitions.
The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:
"Alternate Durable DNR jewelry" means a Durable DNR bracelet or necklace issued by a seller approved by the Virginia Office of Emergency Medical Services.
"Board" means the State Board of Health.
"Cardiac arrest" means the cessation of a functional heartbeat.
"Commissioner" means the State Health Commissioner.
"CPR" or "cardiopulmonary resuscitation" shall include cardiac compression, endotracheal intubation and other advanced airway management, artificial ventilation, defibrillation, administration of cardiac resuscitative medications, and related procedures.
"Durable Do Not Resuscitate Order" or "Durable DNR Order" means a written physician's order issued pursuant to § 54.1-2987.1 of the Code of Virginia in a Durable Do Not Resuscitate Order form authorized by the board, to withhold cardiopulmonary resuscitation from an individual in the event of cardiac or respiratory arrest. For purposes of this chapter, a Durable Do Not Resuscitate Order or Other DNR Order shall not be construed as an advance directive. When used in this chapter, the term "Durable DNR Order" shall include any authorized Alternate Durable DNR jewelry issued in conjunction with an original Durable DNR Order. "Durable DNR Order" shall also include a physician order for scope of treatment (POST) or physician orders for life sustaining treatment (POLST) form. Durable DNR Order Forms, including POST or POLST forms, shall be filled out and signed by a physician and signed by the patient or patient's authorized representative.
"Emergency medical services" or "EMS" shall have the same meaning as in § 32.1-111.1 of the Code of Virginia.
"Emergency medical services agency" or "EMS agency" shall have the same meaning as in § 32.1-111.1 of the Code of Virginia.
"Emergency medical services personnel" or "EMS personnel" shall have the same meaning as in § 32.1-111.1 of the Code of Virginia.
“Health care personnel" means any qualified emergency medical services personnel and any licensed health care practitioner functioning in any facility, program, or organization operated or licensed by the State Board of Health, the Department of Social Services, or the Department of Behavioral Health and Developmental Services (DBHDS) or operated, licensed, or owned by another state agency, or a continuing care retirement community registered with the State Corporation Commission pursuant to Chapter 49 (§ 38.2-4900 et seq.) of Title 38.2 of the Code of Virginia.
"Incapable of making an informed decision" shall have the same meaning as in § 54.1-2982 of the Code of Virginia.
"Office of EMS" or "OEMS" means the Virginia Office of Emergency Medical Services within the Virginia Department of Health (VDH).
"Other Do Not Resuscitate Order" or " other DNR Order" means a written physician's order not to resuscitate a patient in the event of cardiac or respiratory arrest on a form other than the authorized state standardized Durable DNR Order Form, POST form, or POLST form under policies and procedures of the health care facility to which the individual who is the subject of the order has been admitted.
"Person authorized to consent on the patient's behalf" means any person authorized by law to consent on behalf of a patient incapable of making an informed decision as defined by § 54.1-2982 of the Code of Virginia or, in the case of a minor child, the parent or other legal guardian having custody of the child.
"Physician" means a person licensed to practice medicine in the Commonwealth of Virginia or in the jurisdiction where the treatment is to be rendered or withheld.
"Qualified health care facility" means a facility, program, or organization operated or licensed by the State Board of Health, the Department of Social Services, or by the Department of Behavioral Health and Developmental Services (DBHDS) or operated, licensed, or owned by another state agency and licensed health care practitioners at any continuing care retirement community registered with the State Corporation Commission pursuant to Chapter 49 (§ 38.2-4900 et seq.) of Title 38.2 of the Code of Virginia.
"Respiratory arrest" means cessation of breathing.
Statutory Authority
§§ 32.1-12, 32.1-111.4, and 54.1-2987.1 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; Volume 33, Issue 3, eff. November 19, 2016; Volume 42, Issue 10, eff. February 12, 2026.
12VAC5-66-20. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 18, Issue 12, eff. March 27, 2002; repealed, Virginia Register Volume 42, Issue 10, eff. February 12, 2026.
12VAC5-66-30. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 18, Issue 12, eff. March 27, 2002; repealed, Virginia Register Volume 42, Issue 10, eff. February 12, 2026.
12VAC5-66-40. The Durable Do Not Resuscitate Order Form.
The Durable DNR Order Form shall be a standardized document approved by the board and consistent with this chapter, including the following requirements:
1. 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. A signed Durable DNR Order shall remain valid until revoked in accordance with § 54.1-2987.1 of the Code of Virginia or until rescinded, in accordance with accepted medical practice, by the provider who issued the Durable Do Not Resuscitate Order.
3. A Durable DNR Order shall be valid for the purposes of withholding or withdrawing cardiopulmonary resuscitation by health care personnel in the event of cardiac or respiratory arrest.
4. An original or a legible photocopy of the Durable DNR Order Form, POST Form, or POLST Form shall be readily available to health care personnel at the patient's current location.
5. Three identical Durable DNR Order Forms shall be filled out and distributed as follows:
a. Copy one - to be kept by the patient.
b. Copy two - to be kept in the patient's permanent record.
c. Copy three - to be used to order Alternate Durable DNR jewelry.
6. A Durable DNR Order or Other DNR Order may only be revoked in accordance with § 54.1-2987.1 D of the Code of Virginia.
Statutory Authority
§§ 32.1-12 , 32.1-111.4, and 54.1-2987.1 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; Volume 42, Issue 10, eff. February 12, 2026.
12VAC5-66-50. Authorized Alternate Durable DNR jewelry.
A. Alternate Durable DNR jewelry items shall be uniquely-designed, uniquely-identifiable, and available only from a seller approved by the Office of EMS.
B. Only the patient to whom a Durable DNR Order Form applies, or the person authorized to consent on the patient's behalf may purchase Alternate Durable DNR jewelry.
C. The person to whom a Durable DNR Order Form applies or the person authorized to consent on the patient's behalf shall present the Durable DNR Order to the approved seller for purchase of approved Alternate Durable DNR jewelry.
D. The Alternate Durable DNR jewelry shall display the following information:
1. The words: Do Not Resuscitate;
2. The patient's full legal name;
3. The physician's name and telephone number; and
4. The Virginia Durable DNR issuance date.
Statutory Authority
§§ 32.1-12, 32.1-111.4, and 54.1-2987.1 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; Volume 42, Issue 10, eff. February 12, 2026.
12VAC5-66-60. Other DNR Orders.
A. Nothing in this chapter shall be construed to preclude licensed health care practitioners from following any Other Do Not Resuscitate Order in accordance with the applicable policies and procedures of the health care facility in which they practice.
B. Health care personnel shall honor an Other Do Not Resuscitate Order as if it were a Durable Do Not Resuscitate Order if the Other DNR Order includes the information required in 12VAC5-66-40 and the patient is admitted to or in transit from a qualified health care facility, except that an Other DNR Order shall not be required to include the signature of the patient or a person authorized to consent for the patient on the order itself.
C. Nothing in this chapter shall prohibit health care personnel from following a direct verbal order issued by a licensed physician not to resuscitate a patient in cardiac or respiratory arrest when the physician is physically present.
Statutory Authority
§§ 32.1-12 , 32.1-111.4, and 54.1-2987.1 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; Volume 42, Issue 10, eff. February 12, 2026.
12VAC5-66-70. (Repealed.)
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; repealed, Virginia Register Volume 42, Issue 10, eff. February 12, 2026.
12VAC5-66-80. Durable DNR Order implementation procedures.
A. Health care personnel shall follow the procedures in this section when caring for a patient who is in cardiac or respiratory arrest and who may have a Durable DNR Order in effect.
B. Health care personnel shall initiate routine patient assessment and resuscitation or intervention until a valid Durable DNR Order or Other DNR Order can be confirmed.
C. Health care personnel may withhold or terminate resuscitation efforts only when:
1. An intact, unaltered original or photocopy of the Durable DNR Order Form, POST Form, or POLST Form, approved Alternate Durable DNR jewelry or Other DNR Order is located; and
2. The patient for whom the Durable DNR Order or Other DNR Order was issued is verified by identification with a photograph and signature or by positive identification by a family member or other person who knows the patient.
D. If the Durable DNR Order or Other DNR Order is intact, unaltered, and verified as issued for the patient, health care personnel may consider it valid.
E. In the event of cardiac or respiratory arrest of a patient with a valid Durable DNR Order or Other DNR Order, health care personnel shall withhold or withdraw cardiopulmonary resuscitation (CPR) unless otherwise directed by a physician physically present at the patient's location.
F. Health care personnel may provide the following interventions to a patient with a valid Durable DNR Order or Other DNR Order to provide comfort care or to alleviate pain.
1. Airway management, including positioning, nasal, or pharyngeal airway placement;
2. Suctioning;
3. Supplemental oxygen delivery devices;
4. Pain medications or intravenous fluids;
5. Bleeding control;
6. Patient positioning; or
7. Other therapies deemed necessary to provide comfort care or to alleviate pain.
G. If following a Durable DNR Order or Other DNR Order for a particular patient admitted to a qualified health care facility, health care personnel shall document care rendered or withheld as required by facility policies and procedures. If following a Durable DNR Order or Other DNR Order for a particular patient who is not admitted to a qualified health care facility or who is in transit from a health care facility, health care personnel shall document in the patient's medical record the care rendered or withheld in the following manner:
1. Describe assessment of the patient's cardiac or respiratory arrest status;
2. Document which identification (e.g., Durable DNR Order Form, Alternate Durable DNR jewelry, Other DNR Order, or alternate form of identification) was used to confirm Durable DNR status and that it was intact, not altered, and not revoked; and
3. Record the name of the patient's physician who issued the Durable DNR Order or Other DNR Order.
H. If the patient is being transported, the Durable DNR Order or Other DNR Order shall remain with the patient.
I. If family or others present at the patient's location contest the Durable DNR Order or Other DNR Order, EMS personnel shall contact the patient's physician or EMS medical control for guidance.
J. If there is any question about the validity of a Durable DNR Order, resuscitative measures shall be administered until the validity of a Durable DNR Order or Other DNR Order is confirmed.
Statutory Authority
§§ 32.1-12, 32.1-111.4, and 54.1-2987.1 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; Volume 42, Issue 10, eff. February 12, 2026.
Forms (12VAC5-66)
Durable Do Not Resuscitate Order - Virginia Department of Health, EMS-7105 (eff. 6/2011)
National POLST Form (eff. 4/2023)
Virginia Physician Order for Scope of Treatment Form (rev. 5/2017)