West Virginia Do Not Resuscitate (DNR) Form – Sample

West Virginia Do Not Resuscitate (DNR) Form – Sample

West Virginia do not resuscitate form allows an individual to indicate they do not wish to be revived in the event of a medical emergency. The DNR form is reserved for patients who are frail or have a serious illness. This ensures that CPR will not be performed only if the patient’s heart stops or they stop breathing.

Last updated June 26th, 2025

West Virginia do not resuscitate form allows an individual to indicate they do not wish to be revived in the event of a medical emergency. The DNR form is reserved for patients who are frail or have a serious illness. This ensures that CPR will not be performed only if the patient’s heart stops or they stop breathing.

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Signing Requirements

The patient and the health care provider must sign the document.[1]

Form Requirements

Individuals can request the form from their health care provider. The patient must complete the DNR form with a health care clinician present.[2]

Do Not Resuscitate (Preview)