Virginia has approved the National POLST Form as its portable medical order for CPR and treatment intensity, and the Virginia Department of Health's Office of EMS hosts a fillable version with a Virginia notice. It is meant for patients with a serious life-limiting condition or advanced frailty. Clinicians complete it after an advance care planning discussion, and Virginia recognizes it as a DNR order under 12VAC5-66.
The POLST is not valid until signed by a physician, nurse practitioner or physician assistant with a bona fide relationship with the patient; the patient or representative signs Section E. A trained POLST Advance Care Planning Facilitator may help with the discussion.
Download the current version from the source each time; forms change without notice.
National POLST Form: A Portable Medical Order (Virginia)
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Yes. The Virginia POST form may still be used and remains valid, but it is no longer sold, and VDH recommends transitioning to the National POLST form. Other DNR forms, such as the Virginia Durable DNR order and approved DNR jewelry, continue to be recognized under 12VAC5-66-10.
A physician, nurse practitioner or physician assistant who has a bona fide relationship with the patient. The form is not valid until signed, and the Virginia notice points to Code of Virginia 54.1-2957.02 and 54.1-2952.2 for nurse practitioners and physician assistants. Verbal orders are acceptable with a follow-up signature.