How to Complete the Vermont DNR/COLST Form: Signing and Registry

The Vermont DNR/COLST form is a portable medical order that records your decisions about resuscitation and life-sustaining treatment and becomes binding once a licensed clinician signs it. You complete it in conversation with a physician, osteopathic physician, advanced practice registered nurse, or physician assistant, working through six sections that cover CPR, intubation, the overall intensity of medical intervention, antibiotics and artificial nutrition and hydration, contact information for your decision-makers, and periodic review.¹ After signing, the form travels with you between home, hospital, and long-term care.

Who the Form Is Meant For

The DNR/COLST is not a general planning document. The Vermont Ethics Network identifies three groups who should consider it: people with serious, advanced, or life-limiting medical conditions; people who are certain they want to avoid life-sustaining treatments; and people who might die within the next year.² If you are generally healthy, a standard advance directive is the right document instead. The DNR/COLST reflects your current medical condition, not hypothetical future scenarios, and its orders come out of a shared decision with your clinician based on your diagnosis, values, and treatment goals.³

Getting the Official Form

Use the Vermont Department of Health’s designated version. It is available as a free download from the Department of Health website, and you can also get a copy from your primary care provider, hospital, or hospice agency.³ Homemade documents and forms from other states do not qualify as a valid Vermont DNR/COLST.¹

Working Through the Six Sections

You will fill out the form with your clinician, but reading through each section first lets you bring considered preferences to the conversation.

Section A: Cardiopulmonary Resuscitation

Section A asks the core question. If your heart or breathing stops, do you want resuscitation attempted? You pick one of two options:

Yes CPR: attempt resuscitation, including chest compressions, intubation, mechanical ventilation, defibrillation, and transfer to a hospital.
No CPR (DNR): do not attempt resuscitation, and allow natural death.

The section also records the basis for a DNR order, whether that is informed consent from the patient or representative, or a medical determination of non-benefit. The person giving informed consent signs or provides verbal consent directly on the form.⁴

Section B: Intubation and Ventilation

This section is about a breathing tube and mechanical ventilator if you cannot breathe on your own. The choices are a trial course for a limited period; no intubation or ventilation; or yes, intubate and ventilate as needed. You cannot select “no” here if you chose “Yes CPR” in Section A, because CPR itself involves intubation. Section B lets you draw a line you might want, such as agreeing to resuscitation but not to long-term ventilator support.⁴

Section C: Medical Intervention Guidelines

Section C sets the overall approach to your care. You choose one of three tiers:

Focus on Sustaining Life: full treatment, including life support measures and intensive care, using all medically indicated interventions.
Avoid Invasive Interventions: antibiotics, IV fluids, and cardiac monitoring as needed, but no intubation or mechanical ventilation. Less invasive airway support such as CPAP or BiPAP may be considered. Hospital transfer is possible, but intensive care is generally avoided.
Comfort-Focused Treatment (Allow Natural Death): relieve pain and suffering through medication, positioning, wound care, oxygen, and suction. No hospital transfer for life-sustaining treatments, only if comfort needs cannot be met in the current location.

Every tier includes comfort measures. What differs is how aggressively the medical team treats the underlying condition.⁴

Section D: Other Life-Sustaining Treatments

Section D covers three categories separately, each with its own set of choices:

Antibiotics: yes, administer; no, do not use; determine use when infection occurs with comfort as the goal; or did not discuss.
Artificial nutrition: yes; trial course (short-term only, no long-term); no; or did not discuss.
Artificial hydration: yes; trial course (short-term); no; or did not discuss.

The “did not discuss” option is there because a single conversation may not cover every treatment, and you can revisit these decisions later. This section has its own informed-consent signature line for the person authorizing the orders.⁴

Section E: Additional Information

Section E records contact information for a health care agent named in your advance directive, a court-appointed guardian, a surrogate, or a hospice agency. This gives providers a fast route to the right decision-maker if you cannot communicate.

Section F: Reviews

Section F is where you document periodic reviews. Each entry records the date, the reviewer’s name, and the outcome: orders unchanged, new form completed, or existing form voided. Regular review keeps the orders lined up with your medical condition as it evolves.

Signing and What Makes the Form Binding

A completed form is not enforceable until a clinician signs it. Under Vermont law, that signature turns your preferences into a binding medical order.¹ A clinician here means a medical doctor (MD), osteopathic physician (DO), advanced practice registered nurse (APRN), or physician assistant (PA) licensed in Vermont and practicing within scope.⁵

For a DNR order, the clinician must certify that they consulted, or made an effort to consult, with the patient and any appointed agent or guardian. The form must include the name and relationship of the person giving informed consent. If you are in a hospital, nursing home, or residential care facility, the form must also confirm that the facility’s own DNR protocol requirements have been met. The clinician places a copy in your medical record and gives you instructions on how to display the form.¹

Who Can Consent for You

If you lack capacity to make your own medical decisions, someone else can provide or withhold informed consent. Vermont law recognizes three categories of representative, in priority order:

Health care agent, appointed through your advance directive. A surrogate generally cannot override an agent.
Guardian, appointed by a court.
Surrogate, either an interested individual you designate by personally telling your clinician, or, if you have not designated anyone, a willing and available interested individual identified by the clinician.

Your healthcare provider cannot act as surrogate unless related to you by blood, marriage, civil union, or adoption. The same restriction applies to owners, employees, or contractors of the facility where you live at the time. No one can serve as surrogate over your objection, even if you lack decision-making capacity.⁶

Registering with the Vermont Advance Directive Registry

Once signed, your form is legally valid. Registering it with the Vermont Advance Directive Registry (VADR) is optional and free, and it lets authorized healthcare providers pull up your orders during an emergency even if the paper copy is not with you.⁷

You can submit through any of these routes:

Online upload through the VADR portal. No separate registration agreement is required with an online upload.
Mail to Vermont Ethics Network, 61 Elm Street, Suite 1, Montpelier, VT 05602, with a signed VADR Registration Agreement/Authorization to Change form.
Fax to 1-802-828-2646, with the registration agreement included.
Email to VADRSupport@vtethicsnetwork.org, with the registration agreement attached.

If paperwork is missing or incomplete, VADR returns the submission with resubmission instructions.⁸ Review takes about one to two weeks. Once your document is verified, you receive a confirmation letter and a VADR wallet ID card listing your name, date of birth, registration ID number, and primary emergency contact.⁹

Displaying and Transporting the Form

The order only works if responders can find it. Many people keep the original on the front of the refrigerator or in a visible spot near the bed. Your clinician is required to give you instructions on appropriate display when signing the order.¹ When a clinician issues a DNR order, they must also authorize a DNR identification, a wearable bracelet or necklace, so EMS can verify your status when the paper form is not immediately visible.

The form must accompany you during any transfer between care settings, including ambulance transport, hospital admission, a move to a rehab facility, or discharge home. Facilities may document the orders in their own records using their own format while you are in their care, but the portable form remains the controlling document outside the facility.¹

Updating or Revoking the Order

Your orders can change when your medical situation or your preferences change. Section F records periodic reviews, with each outcome noted as no change, new form completed, or form voided. If you want different treatment instructions, your clinician completes a new form that replaces the old one.

You can revoke the order entirely, even if you lack decision-making capacity at the time, through any of these methods:

Sign a written statement of revocation.
Personally tell your clinician, who must document the revocation in your medical record.
Physically destroy the document by burning, tearing, or obliterating it, yourself or by directing someone else to do so in your presence.

An oral statement or any other act showing a clear intent to revoke is also sufficient for revoking treatment orders. Revoking the designation of an agent follows different rules.¹⁰ If you registered with VADR, update the registry too so the database does not show outdated orders.

Provider Obligations and Travel Out of State

Every healthcare provider, hospital, and residential care facility in Vermont must honor a valid DNR/COLST order or DNR identification. A provider can override the order only with a good-faith belief, after consulting any appointed agent or guardian, that the patient wants the order revoked, or that the person wearing a DNR identification is not the individual the order was issued for. The basis for that belief must be documented in the medical record.¹

If you move to Vermont or travel here from another state, Vermont providers must honor an out-of-state DNR order, life-sustaining treatment order, or DNR identification in good faith, provided nothing suggests the document is invalid.¹ The reverse is not automatic. Other states use different names for similar orders, including POLST, POST, MOLST, and MOST, and no uniform interstate reciprocity agreement covers them. If you spend significant time in another state, ask a clinician there whether your Vermont form will be recognized or whether completing that state’s equivalent order would be prudent.

1
Vermont General Assembly. Vermont Statutes Title 18 9708 – Authority and Obligations of Health Care Providers Regarding DNR Orders and COLST
2
Vermont Ethics Network. DNR/COLST Brochure
3
Vermont Department of Health. Do Not Resuscitate (DNR)/Clinician Orders for Life-Sustaining Treatment (COLST)
4
Vermont Ethics Network. Vermont DNR/COLST Form
5
Vermont General Assembly. Vermont Statutes Title 18 9701 – Definitions
6
Vermont General Assembly. Vermont Statutes Title 18 9731 – Informed Consent by Surrogate for DNR/COLST Order
7
Vermont Ethics Network. Vermont Advance Directive Registry
8
Vermont Department of Health. Create, Register and Make Changes to an Advance Directive
9
Vermont Ethics Network. How to Register
10
Vermont General Assembly. Vermont Statutes Title 18 Chapter 231 – Section 9704 Amendment, Suspension, and Revocation