Advance Directives

Do Not Resuscitate (DNR)/Clinician Orders for Life-Sustaining Treatment (COLST)

Fri, 27 Jan 2017 20:48:55 +0000

Do Not Resuscitate (DNR)/Clinician Orders for Life-Sustaining Treatment (COLST)

DNR (Do Not Resuscitate)/COLST (Clinician Order for Life-Sustaining Treatment)
- DNR/COLST orders are portable, out-of-hospital medical orders used to instruct medical providers and emergency responders about any treatment limitations for an individual. DNR/COLST orders are the outcome of a shared decision-making process between a patient (or their agent, guardian or surrogate, if the patient lacks decision-making capacity) and their clinician (MD, DO, PA or APRN). They are based on an individual’s current medical condition and their goals and values. DNR/COLST orders are not advance directives. If emergency responders are called, they cannot withhold any treatments unless there is a DNR/COLST order in place and clearly displayed for EMTs/EMS to find.
- DNR/COLST orders address the following medical treatments:
  - Cardiopulmonary resuscitation (CPR)
  - Breathing machines (intubation and ventilation)
  - General guidelines for medical treatments
  - Artificial feeding and fluids
  - Antibiotics
If you are certain that you would not want one or more of these treatments regardless of the medical situation you are in, it is important to have a discussion with your clinician to see if a DNR/COLST order is right for you.
Do Not Resuscitate (DNR) order is a written order by the patient’s clinician directing health care providers not to attempt resuscitation.
Clinician Orders for Life-Sustaining Treatment (COLST) is a clinician’s order(s) for treatment. This may include limitations on treatment or medical interventions. It may also include a DNR order.

Read the Advance Directives for Health Care Rule

DNR/COLST Clinician Order Form & Instructions

In the out-of-hospital setting (out-patient), DNR/COLST orders must be issued on the Vermont DNR/COLST form below. Properly executed DNR/COLST orders do not expire but should be reviewed when there is a change in the patient's health status, care setting, or goals. DNR/COLST orders and other similar portable medical orders (MOLST, POLST) properly completed in another state will be honored in Vermont.
In the hospital, medical orders are documented in the patient's medical record, in a facility-specific manner. The Vermont DNR/COLST form should only be used if a patient is being discharged with a treatment limitation in place. DNR/COLST orders should not be completed for patients who have no limitations of treatment.
The DNR/COLST form was updated in June 2022.

Vermont DNR/COLST Form

For Patients with DNR/COLST Orders
- Keep your order in your home, clearly displayed on the refrigerator. (link to order File of Life magnets)
  - If you live in an assisted living facility, nursing home or other facility, check with the staff to find out their policy on where DNR/COLST orders should be displayed for emergency responders.
- Make additional copies of the order for your vehicle, or to carry when you travel.
- DNR/COLST orders are the responsibility of the patient (or their surrogate). Patients being admitted to the hospital and who want their DNR/COLST order to be in effect must bring a copy of their order to the hospital.
- Tell your health care agent, close family members and friends that you have a DNR/COLST order so that they are aware of your care plan and can support you if needed.

Approved DNR Medical ID Vendors

Individuals may wish to purchase wearable Do Not Resuscitate (DNR) identification. The Health Department has approved the following vendors:

ADMIN_bailey.bradley Fri, 01/27/2017 - 15:48

Create, Register and Make Changes to an Advance Directive

Mon, 18 Jul 2016 14:52:09 +0000

Create, Register and Make Changes to an Advance Directive

An advance directive is a written document that outlines your wishes for medical treatment in the future, including if you are no longer able to make those decisions. The State of Vermont contracts with the Vermont Ethics Network to provide education and support for advance care planning and customer support for the Vermont Advance Directive Registry. Registration is free.

Create an Advance Directive | Change an Advance Directive

As of July 1, 2024, the Vermont Advance Directive Registry policies and submission procedures have been updated. The changes are reflected in these instructions. You can also read the memo describing the updates.

Create and Register an Advance Directive

1. Complete and sign an advance directive form

Click on the form types below to learn more about and download the forms. You can also choose one from another organization of your choice. Vermont law does not favor one over another. If you already have an advance directive, please go to step 2.

Please note: Vermont advance directives require the signature of two adult witnesses. Witnesses cannot be your appointed health care agent, spouse, siblings, parents, children or grandchildren.

vdhadmin Mon, 07/18/2016 - 10:52

Provider Authorization and Obligations

Mon, 18 Jul 2016 14:52:09 +0000

Provider Authorization and Obligations

Health care facilities and provider who have already been authorized to access advance directives can access the Vermont Advance Directive Registry by clicking on the button below.

Provider Login for Registry

Become an Authorized Provider

Becoming an authorized health care facility or provider allows for quick access to patients' advance directives in the Vermont Advance Directives Registry.

Complete the Advance Directive Provider Application.
Mail the application and agreement to:
Vermont Advance Directive Registry
Vermont Department of Health
280 State Dr., Waterbury, VT 05671-8370
Your application and agreement will be reviewed.
Once approved, the registry will contact you with instructions and registry account number.

Authorized providers agree to:

Protect the issued identification number issued. Limit access to the identification number to employees with a need to access the registry.
Train employees on the proper use of the registry and the registrants’ documents, and the obligation to report any unauthorized access or misuse of information to the Vermont Department of Health.
Inform the registry as soon as possible, in writing, of any change or proposed change to the information contained in the original Provider Access Application form submitted to the registry.

vdhadmin Mon, 07/18/2016 - 10:52