(DNR) CONSENT FORM - Central State Hospital - centralstatehospital 2025

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  1. Click ‘Get Form’ to open the DNR Consent Form in the editor.
  2. Begin by entering the client's name in the designated field at the top of the form.
  3. Indicate whether the client has decision-making ability by selecting 'YES' or 'NO' in the appropriate section.
  4. If applicable, have the client or authorized family member sign and date their consent for a DNR order in the respective fields provided.
  5. For clients without decision-making capacity, ensure an authorized family member completes their section, including signature and relationship to the client.
  6. If there is no authorized family member, note that approval from the CSH Ethics Forum is required and ensure it is signed and dated.
  7. Complete any necessary cancellation or revocation sections if applicable, ensuring all signatures are obtained where required.

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Central State Hospital provides civil inpatient psychiatric services to the Central Virginia area, as well as forensic maximum security inpatient psychiatric services to the entire Commonwealth. Our H.O.P.E. is that we provide a place of healing to support individuals recovery.
In December 1869, a former Confederate Facility, known as Howards Grove Hospital, was designated as a mental health hospital for African-Americans. The name was later changed to Central Lunatic Asylum.
First listed as a Places in Peril site in 2010, Central State Hospital has continued to suffer from neglect since its full closure in 2013, leading to further deterioration. A redevelopment authority is working to manage the site, and the train depot is being repurposed into Georgias Old Capital Museum.