Virginia POLST and DNR Forms

Portable medical orders like POLST and DNR ensure that your loved one's medical treatment and resuscitation preferences are consistently followed.

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Helpful Highlights

  • It is strongly encouraged that you read the following Helpful content Guides before selecting a POLST and/or DNR form:

    • An Advance Directive by Any Other Name...

    • Physician Orders for Life-Sustaining Treatment (POLST)

    • Do Not Resuscitate (DNR) Order

  • The signed POLST and/or DNR form must be in English.

  • Below are POLST and DNR forms available in Virginia.

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POLST and DNR requirements

Unlike other forms that can be self-created and legally binding POLST and DNR forms require the review and signature of a healthcare provider. The forms are invalid if not signed by a provider.

Some states simply use the National POLST form and not a POLST form specific to that state. The National POLST form is acceptable for states with POLST programs but without specific forms.

While POLST and DNR forms are available in various languages for ease of education and understanding, the signed forms must be in English.

VIRGINIA POLST

English

VIRGINIA DNR

English (fillable)

RESOURCES

VA POLST -and- VA Dept of Health

eForms - VA DNR (Electronic Forms LLC, 2023)

National POLST Site

National POLST Map (click on your state)

While the documents contained here are binding when properly executed, no content in this app, regardless of date, should ever be used as a substitute for any direct medical guidance you receive from your provider or other qualified medical professionals.

Likewise, no content in this app, regardless of date, should ever be used as a substitute for any direct legal advice you receive from your lawyer or other qualified legal professionals.

Go to all guides

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