Vermont Do Not Resuscitate FormVermont Do Not Resuscitate FormVermont Do Not Resuscitate Form
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INSTRUCTIONS FOR CLINICIANS
COMPLETING VERMONT DNR/COLST FORM
(DO NOT RESUSCITATE ORDER/CLINICIAN ORDERS FOR LIFE SUSTAINING TREATMENT)

Completing DNR/COLST
• The DNR/COLST form must be completed and signed by a health care clinician based on patient preferences
and medical indications. A clinician is defined as a medical doctor, osteopathic physician, advance practice
registered nurse or physician assistant. 18 V.S.A. § 9701(4). Verbal orders are acceptable with follow-up
signature by the clinician in accordance with facility/community policy.
• Photocopies and Faxes of signed COLST forms are legal and valid; use of original is encouraged.
Special requirements for completing the DNR section of COLST (18 V.S.A. §9708)
• A DNR order may be written on the basis of either informed consent or futility. Complete section A-2 for
informed consent; Section A-3 for futility.
• An order based on informed consent must include the name of the individual giving informed consent.
• An order based o