Administrative Code

Virginia Administrative Code
8/8/2022

Part III. Requirements and Provisions

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shall remain valid until revoked in accordance with § 54.1-2987.1 of the Code of Virginia and 12VAC5-66-80 E or until rescinded, in accordance with accepted medical practice, by the provider who issued the Durable Do Not Resuscitate Order.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

12VAC5-66-50. Authorized alternate Durable DNR jewelry.

The board authorizes the use of Alternate Durable DNR jewelry in conjunction with the issuance of a Durable DNR Order. These Alternate Durable DNR jewelry items shall be uniquely-designed and uniquely-identifiable bracelets and necklaces that are available only from a vendor approved by the Virginia Department of Health, Office of EMS. The Alternate Durable DNR jewelry must be purchased from the approved vendor by the person to whom a Durable DNR Order Form applies, or the person authorized to consent on the patient's behalf. An original Durable DNR Order Form must be obtained from a physician and provided to the vendor in order to receive Alternate Durable DNR jewelry. Such a necklace or bracelet may be utilized either to validate the Durable DNR Order Form or in place of an original Durable DNR Order Form in the event that the original order is not readily available at the site where the person to whom the order applies is found. In order to be honored by qualified health care personnel in place of the standard Durable DNR Order Form, the Alternate Durable DNR jewelry must contain the minimum information approved by the State Board of Health in 12VAC5-66-60.

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.

12VAC5-66-60. Other DNR Orders.

A. Nothing in these regulations 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. Qualified health care personnel are authorized to honor any Other Do Not Resuscitate (DNR) Order as if it were a Durable Do Not Resuscitate Order when the patient is currently admitted to a hospital or other qualified health care facility or is in transit from a qualified health care facility provided that such order includes the same information as listed in subdivision 1 of 12VAC5-66-40, 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 these regulations shall prohibit qualified health care personnel from following any direct verbal order issued by a licensed physician not to resuscitate a patient in cardiac or respiratory arrest when such physician is physically present.

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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