How to Get a DNR in Virginia: Durable Do Not Resuscitate Order Guide

Writing "do not resuscitate" in your advance directive doesn't stop paramedics from performing CPR at your home. Virginia EMS crews are legally required to attempt full resuscitation unless they're presented with a specific physician-signed order — the Durable Do Not Resuscitate (DDNR) form — or approved DDNR jewelry. Here's exactly how to get one.

What a Virginia DDNR Covers

A DDNR order issued under Virginia Code § 54.1-2987.1 instructs all pre-hospital personnel and clinical providers to withhold five specific interventions in the event of cardiac or respiratory arrest:

• Cardiopulmonary resuscitation (CPR)
• Cardiac compression
• Endotracheal intubation
• Artificial ventilation
• Defibrillation

The order applies in every setting — home, nursing facility, ambulance, and hospital. It doesn't address broader treatment preferences like artificial nutrition, antibiotics, or pain management. For those, you need a POLST form in addition to the DDNR.

The Two Signatures Required

A Virginia DDNR must be signed by two people:

A physician with whom the patient has a bona fide clinical relationship. This is typically the patient's primary care physician, but can be any treating physician, including a hospitalist or specialist managing a terminal condition. The physician must have a genuine doctor-patient relationship — you can't get a DDNR from a doctor who's never treated you.

The patient or their authorized representative. If the patient has decision-making capacity, they sign personally. If the patient lacks capacity, an authorized healthcare agent (named in an advance directive) or a default statutory surrogate under Va. Code § 54.1-2986 can sign on their behalf.

How to Request One

The process starts with your physician. Call your primary care doctor's office and request an appointment to discuss your end-of-life care preferences. During the appointment:

1. Discuss your medical condition and prognosis
2. Explain that you want a DDNR order to prevent unwanted resuscitation
3. The physician completes and signs the standardized DDNR form
4. You sign the form
5. The physician provides you with the original yellow form

The form itself is free — physicians provide it as part of clinical care. There's no filing fee or court involvement.

Where to Keep It

The DDNR must be physically accessible to EMS crews during an emergency. Best practices:

At home: Post the original signed yellow form on the refrigerator. Virginia rescue squads are trained to check the refrigerator first when looking for medical orders. Taping it to the inside of the front door is a secondary option.

In a nursing facility or assisted living: The facility keeps the DDNR in your medical chart and posts a copy at your bedside. Staff notify EMS on arrival.

On your person: When you leave home, carry a legible photocopy on white paper. EMS can honor a photocopy as long as it's legible and contains all required information.

DDNR Jewelry as an Alternative

Virginia law authorizes approved DDNR jewelry — bracelets or necklaces — as a legal substitute for the paper form. To be valid, the jewelry must contain three pieces of information: the patient's name, the physician's name, and the date the DDNR was issued.

The jewelry must be purchased from a state-approved vendor. A standard medical alert bracelet that says "DNR" without the required physician information is not legally sufficient — EMS crews cannot honor it.

DDNR jewelry is particularly useful for patients who are active outside the home and can't carry the paper form everywhere. It serves as an immediately visible signal to first responders.

Revoking a DDNR

A patient with decision-making capacity can revoke a DDNR at any time by destroying the form, removing the jewelry, or verbally telling medical personnel they want resuscitation. If the patient personally signed the DDNR and later loses capacity, the "No CPR" designation cannot be revoked by a family member or surrogate.

If the DDNR was signed by an authorized representative rather than the patient, and the patient later demonstrates a desire for resuscitation (even nonverbally), EMS must attempt resuscitation.

Coordinating DDNR with Your Advance Directive

A DDNR handles one specific emergency scenario — cardiac or respiratory arrest. Your advance directive handles everything else: long-term treatment preferences, healthcare agent designation, organ donation, psychiatric care instructions, and post-incapacity planning.

The Virginia Advance Directive & Living Will Kit covers both instruments, explains how they interact, and includes the coordination steps for registering everything with the ACPR so your medical team has a complete picture. Get the complete toolkit to make sure your wishes are protected in every scenario.

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