How to Fill Out and Register Your Vermont Advance Directive

A Vermont advance directive is a legal document that names a health care agent to make medical decisions for you and records which treatments you want or refuse if you cannot speak for yourself. Any Vermont adult with decision-making capacity can create one. The state does not require a specific official form, the Vermont Ethics Network publishes free templates, and registering your completed directive with the Vermont Advance Directive Registry is also free.

Pick a Form That Matches What You Want to Decide

Vermont law sets requirements for what a directive may contain rather than mandating a template, so you have options. The Vermont Ethics Network publishes four free fillable forms.¹

The Appointing a Health Care Agent Form is the simplest. Use it if you mainly want to name a decision-maker and don’t need detailed treatment instructions.
The Advance Directive Short Form combines an agent appointment with basic treatment preferences, which works for most people.
The Advance Directive Long Form walks through specific scenarios covering life-sustaining treatment, mental health care, pain management, and organ donation.
The Disability Rights Vermont Advance Directive Form is designed for people with disabilities, with particular attention to psychiatric and behavioral health preferences.

All four include the VADR Registration Agreement so you can register in the same mailing. Download any of them from the Vermont Ethics Network or the Vermont Department of Health.² You can also draft your own document; it is valid as long as it meets Vermont’s execution requirements.

What to Put in the Document

Vermont’s statute lets a directive cover a broad range of topics: naming a decision-maker, specifying treatments you want or refuse, directing mental health care, and making anatomical gifts.³ You don’t have to address every topic. Complete the sections that matter to you and leave the rest blank. The document is still valid.

Your Health Care Agent

Pick someone you trust to follow your values under pressure and who can realistically be reached by a hospital on short notice. Record their full name, phone number, and physical address, and name at least one alternate agent in case your first choice is unavailable or unwilling to serve.

You can grant broad authority to make any health care decision you could make yourself, or you can limit the agent’s powers. For instance, you might grant general authority but reserve decisions about psychiatric medication or feeding tubes for your own written instructions. Whatever scope you choose, spell it out clearly. Vagueness here is where family disputes start.

Under federal HIPAA rules, your agent generally qualifies as your personal representative and can access your medical records once the directive is in effect. Giving your agent a signed copy ahead of time avoids delays if a records department wants proof of authority.

Treatment Preferences

The form asks what life-sustaining treatments you want, which you refuse, and under what circumstances. Common choices include:

Cardiopulmonary resuscitation if your heart or breathing stops.
Mechanical ventilation if you cannot breathe on your own.
Artificial nutrition and hydration if you can no longer eat or drink.
Comfort care, including pain medications or approaches you want or want to avoid.

You can also describe personal or spiritual practices you want observed near the end of life, including music, prayer, the presence of certain people, or the absence of certain interventions. Vermont clinicians are obligated to follow these instructions.

Mental Health Instructions

Vermont explicitly allows an advance directive to cover mental health treatment. You can direct whether you want or refuse specific psychiatric medications, hospitalization, electroconvulsive therapy, or other behavioral health interventions.³ The long form also allows a “Ulysses clause,” a provision stating that certain treatments should be given or withheld even if you object at the time. That provision can only be revoked while you have capacity.⁴

Organ and Tissue Donation

A separate section lets you make, limit, or refuse an anatomical gift. You can specify donation for transplantation, medical research, education, or therapy, or restrict your donation to particular organs or purposes.³

Signing and Witnessing

To be legally valid, your directive must be dated and signed by you (or by someone else at your direction if you cannot physically sign) in the presence of two adult witnesses.⁵ Both witnesses must be at least 18 and must sign a statement affirming that you appeared to understand the document and were free from pressure or undue influence. Notarization is not required.

These people cannot serve as witnesses:⁵

Your appointed health care agent or alternate agent
Your spouse
Your parent
Your adult sibling, adult child, or adult grandchild

Health care providers are not on that list. A nurse, doctor, or social worker you know can witness your directive as long as they are not your named agent or a close family member.

Remote Witnessing

Since April 1, 2024, witnessing by phone or video call is allowed if the witness knows you personally. The remote witness must attest that you seemed to understand the document and were free from duress, and you must list the remote witness’s name, contact information, and your relationship on the directive. Digital signatures are permitted for both you and your witnesses.⁵

Extra Step If You Are in a Hospital or Care Facility

If you are signing while you are a hospital patient or a resident of a nursing home or residential care facility, an additional safeguard applies. Before the directive takes effect, a qualified individual must explain the nature and effect of the document to you and sign a statement confirming they did so. Qualified explainers include an ombudsman, a member of the clergy, a Vermont-licensed attorney, a Probate Court designee, a mental health patient representative, or a trained volunteer at the facility. A clinician can serve as the explainer if they are not employed by the nursing home or residential care facility.⁶ The person who provides the explanation can also serve as one of your two witnesses.

Register with the Vermont Advance Directive Registry

The Vermont Advance Directive Registry (VADR) is a secure database that lets hospitals and authorized providers pull up your directive electronically when you arrive unable to communicate. Vermont hospitals are required to check the VADR when an incapacitated patient is admitted.⁷ Registration is free.² You can register two ways:

Online. Create an account on the VADR website and upload a PDF of your signed directive. You do not need a separate Registration Agreement; you give permission electronically when you create the account.
By mail, fax, or email. Send a copy of your signed directive and the completed VADR Registration Agreement (included with the VEN forms) to the Vermont Ethics Network at 61 Elm Street, Suite 1, Montpelier, VT 05602. The fax number is 1-802-828-2646, and the email address is VADRSupport@vtethicsnetwork.org.

Once your document is processed, you’ll get a confirmation letter by mail that includes a wallet ID card showing your name, date of birth, registration ID number, and primary emergency contact. You’ll also receive VADR stickers that display a 24/7 provider hotline number. Put one on your driver’s license or insurance card so first responders know to call. Authorized providers use two-factor authentication to search the registry and download your directive.⁸

Even with VADR registration, give physical copies to your health care agent, your primary care doctor, and anyone else likely to be present in a medical emergency. The more places your directive lives, the faster it gets into the right hands.

When Your Directive Takes Effect

Your directive does not activate the moment you sign it unless you specifically say it should. In most cases it becomes effective when your clinician determines that you lack capacity to make your own health care decisions. The clinician must document the cause, nature, and expected duration of your incapacity, and must make reasonable efforts to notify both you and your agent.⁹

Once activated, your agent has authority to make any health care decision you could make if you had capacity. The agent must try to figure out what you would have wanted by looking at your written instructions, wishes you’ve expressed, and your known values. If the agent genuinely can’t determine your preference, they fall back on a best-interests standard, but they can never substitute their own preferences and can never base a decision on your economic status or a preexisting disability.⁹

Changing or Revoking Your Directive

You can revoke or change your directive at any time. Vermont recognizes several methods:⁴

Execute a new directive. A later directive automatically overrides any conflicting provisions in an earlier one. The new document must meet the same signing and witnessing requirements.
Sign a written revocation of all or part of the directive.
Tell your clinician. A personal statement to your clinician counts as a valid revocation, and the clinician must document it in your medical record.
Destroy the document by burning, tearing, or obliterating it, either yourself or by someone else at your direction and in your presence.

One nuance matters. You can revoke treatment preferences orally, in writing, or by any act showing intent to revoke, even if you lack capacity at the time. Revoking the designation of your agent, however, requires one of the specific methods above. And a mental health Ulysses clause can only be revoked while you have capacity.⁴

Divorce Automatically Suspends a Spouse Agent

Filing for divorce, annulment, dissolution of a civil union, legal separation, or a relief-from-abuse order automatically suspends your spouse’s designation as your agent. If the case is withdrawn, the designation is reinstated. If the divorce or separation becomes final, the suspension is permanent.⁴ If you are going through a separation and your spouse is your named agent, update your directive or confirm that your alternate agent is still someone you trust.

When to Review

Advance directives don’t expire in Vermont, but a document that’s ten or fifteen years old may reflect values and relationships that no longer match your life. Review yours whenever a major change happens: a new diagnosis, a move, a divorce, the death of your named agent, or adult children reaching an age where they could serve as agents. Even without a triggering event, pulling it out every three to five years and confirming it still says what you mean is a reasonable habit. If you update it, register the new version with the VADR and notify everyone who holds a copy of the old one.

A COLST Order Is Not an Advance Directive

Vermont also uses a document called Clinician Orders for Life-Sustaining Treatment (COLST), and the two are sometimes confused. A COLST is a set of physician’s orders signed by a clinician after a face-to-face conversation about your current medical condition. It tells emergency responders exactly what to do or not do, covering CPR, ventilators, antibiotics, and feeding tubes. EMTs are required to follow COLST orders. They are not required to follow an advance directive in the field.¹⁰ A COLST is appropriate for people who are seriously ill or medically frail. An advance directive is for any adult who wants to plan ahead. If you have both, the COLST governs emergency field treatment while your advance directive guides broader hospital decisions and names your agent.

Out-of-State Directives

Vermont honors advance directives executed in other states. Under 18 V.S.A. § 9716, nothing in Vermont’s advance directive chapter limits the enforceability of a directive executed elsewhere, so long as it was valid under the law of the state where it was signed.⁹ Vermont providers must also honor out-of-state DNR and life-sustaining-treatment orders in good faith. The reverse isn’t guaranteed. Not every state will recognize a Vermont directive, and some will honor an out-of-state document only if it closely resembles their own form. If you split time between Vermont and another state, complete a valid directive for each state and keep copies in both places.

1
Vermont Ethics Network. Forms to Document Health Priorities and Choices
2
Vermont Department of Health. Create, Register and Make Changes to an Advance Directive
3
Vermont General Assembly. Vermont Code 18 VSA 9702 – Advance Directive
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Vermont General Assembly. Vermont Code 18 VSA 9704 – Amendment, Suspension, Revocation
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Vermont General Assembly. Vermont Code 18 VSA 9703 – Execution of Advance Directive
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Vermont General Assembly. Vermont Code Title 18 – Execution of Advance Directive
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Vermont Ethics Network. Vermont Advance Directive Registry
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Vermont Ethics Network. How to Register
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Vermont General Assembly. Vermont Code 18 Chapter 231 – Advance Directives for Health Care, Disposition of Remains, and Surrogate Decision Making
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Vermont Department of Health. Do Not Resuscitate (DNR)/Clinician Orders for Life-Sustaining Treatment (COLST)