Virginia uses a specific document called a Durable Do Not Resuscitate (DDNR) Order, governed by §54.1-2987.1 of the Code of Virginia. This is a written physician’s order that instructs emergency medical personnel to withhold CPR if your heart or breathing stops. The official form is available through the Virginia Department of Health’s Emergency Medical Services website, and it requires both a physician’s signature and the patient’s signature to be valid.
What the DDNR Form Requires
Virginia law sets out clear requirements for a valid Durable DNR Order. The form must include a do not resuscitate determination from a physician who has a genuine, established physician-patient relationship with you. The physician signs the form and dates it, and you (or someone legally authorized to consent on your behalf) also sign it.
Unlike Virginia’s advance medical directive, the DDNR does not require witnesses or notarization. The two signatures, yours and your physician’s, are what make it legally binding. This makes the process simpler, but the physician-patient relationship requirement means you cannot get a DDNR signed by a doctor you’ve never seen before.
How a DDNR Differs From an Advance Directive
These two documents overlap in purpose but work differently. An advance medical directive (sometimes called a living will) lets you spell out your broader wishes for medical care if you develop a terminal condition with no reasonable expectation of recovery, or if you enter a persistent vegetative state. It can also name a healthcare agent to make decisions when you’re unable to. That agent’s authority only kicks in when you can no longer decide for yourself.
A DDNR is narrower. It covers one specific scenario: cardiac or respiratory arrest. Its main advantage is that it travels with you outside the hospital. Emergency medical personnel in the field will honor a DDNR when they respond to a 911 call at your home, at a nursing facility, or anywhere else. A standard advance directive, by contrast, is typically interpreted by hospital staff and your healthcare providers rather than by EMS crews arriving on scene. If you want to prevent resuscitation attempts in an emergency setting, the DDNR is the document designed for that purpose.
Who Can Sign on Your Behalf
If you’re unable to make an informed medical decision, Virginia law allows an authorized person to consent to the DDNR for you. This includes anyone authorized under §54.1-2982 of the Code of Virginia to make healthcare decisions on behalf of an incapacitated adult, such as a healthcare agent named in your advance directive, a legal guardian, or certain family members in a specific order of priority.
For a minor child, a parent or legal guardian with custody can consent to a DDNR on the child’s behalf. The same physician-patient relationship requirement applies: the child must be a patient of the physician who signs the order.
Where to Get the Form
The authorized DDNR form is available for download from the Virginia Department of Health’s EMS website. The VDH also provides a step-by-step guide on how to fill it out correctly. You’ll want to use the official 2017 version of the form (the most recent authorized version), as EMS personnel are trained to recognize it. Using an unofficial or outdated form could create confusion in an emergency.
Virginia also offers an alternative to carrying the paper form at all times. Approved DDNR bracelets and necklaces serve as legally recognized identification. Only the patient named on the DDNR, or the person authorized to consent on their behalf, can purchase this jewelry. You’ll need to present your completed DDNR Order to an approved seller to buy it. Wearing the bracelet or necklace alerts EMS crews to your wishes even if the paper form isn’t immediately available.
How to Revoke a DDNR
You can cancel your DDNR at any time through two methods. The first is physical destruction: you destroy the form yourself, or have someone destroy it in your presence and at your direction. This includes destroying any alternate identification like a bracelet or necklace. The second method is even simpler: you verbally express your intent to revoke. No written paperwork is needed to undo the order.
If an authorized decision maker originally initiated the DDNR on your behalf, that same person can also revoke it using either method. The key principle is that a DDNR is never permanent and never irreversible. If you change your mind, or if circumstances change, the order ends the moment you say so.
What Happens When EMS Responds
When emergency personnel arrive at a scene and find a patient in cardiac or respiratory arrest, their default protocol is to begin resuscitation immediately. A valid DDNR changes that protocol. If EMS crews can verify the order, either by seeing the official form or recognizing approved DDNR jewelry, they will withhold CPR and related resuscitation measures.
This is why having the form accessible matters. If the document is locked in a filing cabinet or stored only with your attorney, EMS personnel have no way to verify your wishes in the critical minutes after they arrive. Many people keep the form posted on their refrigerator or near their bed. The DDNR jewelry offers a more portable solution, especially for people who are active outside the home or who live in assisted care facilities where staff turnover might mean not everyone knows where the paperwork is stored.