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Vermont Do Not Resuscitate (DNR) Order Form

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Updated June 29, 2026

The Vermont Do Not Resuscitate (DNR) order form instructs emergency health care providers to withhold the administration of CPR as desired by the patient. It may also be used to define the interventions approved by the patient to maintain their health and comfort while they can still breathe and when their heart is still beating.
  • Note: The patient’s clinician must be consulted when preparing the document.
  • Laws – § 9708 and § 9709
  • Required to Sign – MD/DO/APRN/PA, and patient (if able to sign) or their representative.

Sample