Vermont Do Not Resuscitate (DNR) Form

Create Document

Vermont Do Not Resuscitate (DNR) Form

A Vermont do not resuscitate form instructs emergency medical personnel that a patient does not wish to receive CPR when they are unresponsive and have no pulse. The Vermont DNR form includes the COLST (Clinician Order for Life-Sustaining Treatment) which allows a patient to express additional medical intervention preferences.

Create Document
PDF

Last updated July 6th, 2025

Document Preview

A Vermont do not resuscitate form instructs emergency medical personnel that a patient does not wish to receive CPR when they are unresponsive and have no pulse. The Vermont DNR form includes the COLST (Clinician Order for Life-Sustaining Treatment) which allows a patient to express additional medical intervention preferences.

Downloads: 4
  1. Home »
  2. Do Not Resuscitate (DNR) Forms »
  3. Vermont

Signing Requirements

The DNR/COLST must be signed by the patient’s clinician.[1]

Patient Limitations

The Vermont DNR/COLST form is only meant to be used when a patient is being discharged from a hospital and has a medical order that limits certain treatments.[2]

Displaying The DNR/COLST

The Vermont Department of Health states that the DNR/COLST order should be displayed on the patient’s fridge. Patients should also have a copy in their vehicle and when traveling.

Individuals who wish to purchase wearable DNR identification may do so through these two approved vendors:

DNR/COLST (Preview)

Sources

  1. § 9708(d)
  2. Vermont Department of Health – DNR/COLST