Legal  Do Not Resuscitate Order Document for Vermont Open Do Not Resuscitate Order Editor

Legal Do Not Resuscitate Order Document for Vermont

A Vermont Do Not Resuscitate (DNR) Order form is a legal document that allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. This form ensures that healthcare providers respect a person's decision not to receive life-saving measures. Understanding and completing this form is an important step in making healthcare choices that align with personal values.

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The Vermont Do Not Resuscitate (DNR) Order form serves as a critical tool for individuals wishing to express their preferences regarding medical interventions in emergency situations. This form is designed to provide clear guidance to healthcare providers about a patient's wishes in the event of cardiac arrest or respiratory failure. By completing this document, patients can ensure that their choices are respected, alleviating the burden on loved ones during emotionally challenging times. The form requires the signature of the patient or their legal representative, along with the endorsement of a physician, thus ensuring that it is both legally binding and medically informed. Importantly, the DNR Order is not a blanket refusal of all medical treatment; rather, it specifically addresses resuscitation efforts, allowing for other forms of care to continue. Understanding the nuances of this form is essential for patients, families, and healthcare professionals alike, as it fosters open communication about end-of-life preferences and promotes dignity in the face of serious health challenges.

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Vermont Do Not Resuscitate (DNR) Order Template

This document serves as a directive pursuant to the Vermont Patient Choice and Control at End of Life Act. It outlines the express wishes of the undersigned patient or their legally recognized health care agent regarding the avoidance of cardiopulmonary resuscitation (CPR) in the event the patient's breathing ceases or the patient's heart stops beating.

Please complete the following information:









In accordance with the directives established under the legal scope of Vermont laws, the undersigned:

  1. Determines that no attempt at resuscitation (including CPR) should be made in the event that their heart stops beating or they cease to breathe, and
  2. Designates a healthcare agent (if applicable), who has been fully informed and has agreed to uphold the patient's wishes as documented in this order.




It is advised that this document be reviewed regularly and after any significant change in the patient's medical condition. Any modification or revocation of this order should be communicated immediately to the primary care physician and, if applicable, the designated health care agent.

By signing below, the patient or their legally authorized representative attests to the accuracy of the information provided and consents to the Do Not Resuscitate order as specified above.









This DNR order must be presented to and followed by all health care providers, including emergency medical services, attending to the patient.

Notice: This document does not create a durable power of attorney for health care. Individuals wishing to designate a health care agent should complete the appropriate Vermont forms.

File Characteristics

Fact Name Description
Governing Law The Vermont Do Not Resuscitate Order form is governed by Title 18, Chapter 231 of the Vermont Statutes Annotated.
Purpose This form allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency.
Eligibility Any adult who is capable of making healthcare decisions can complete the Do Not Resuscitate Order form.
Signature Requirement The form must be signed by the individual or their authorized representative, along with a witness signature.
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