NRS 449A.439
Form of declaration designating another person to decide to withhold or withdraw life-sustaining treatment.

1.

A declaration that designates another person to make decisions governing the withholding or withdrawal of life-sustaining treatment may, but need not, be in the following form:
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DECLARATION
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If I should have an incurable and irreversible condition that, without the administration of life-sustaining treatment, will, in the opinion of my attending physician or attending advanced practice registered nurse, cause my death within a relatively short time, and I am no longer able to make decisions regarding my medical treatment, I appoint ............................... or, if he or she is not reasonably available or is unwilling to serve, .............................., to make decisions on my behalf regarding withholding or withdrawal of treatment that only prolongs the process of dying and is not necessary for my comfort or to alleviate pain, pursuant to NRS 449A.400 to 449A.481, inclusive. (If the person or persons I have so appointed are not reasonably available or are unwilling to serve, I direct my attending physician or attending advanced practice registered nurse, pursuant to those sections, to withhold or withdraw treatment that only prolongs the process of dying and is not necessary for my comfort or to alleviate pain.)
Strike language in parentheses if you do not desire it.
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If you wish to include this statement in this declaration, you must INITIAL the statement in the box provided:
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Withholding or withdrawal of artificial nutrition and hydration may result in death by starvation or dehydration. Initial this box if you want to receive or continue receiving artificial nutrition and hydration by way of the gastrointestinal tract after all other treatment is withheld pursuant to this declaration.
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Signed this ........................ day of ................, ......
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Signature .........................................................
Address ...........................................................
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The declarant voluntarily signed this writing in my presence.
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Witness ...........................................................
Address ...........................................................
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Witness ...........................................................
Address ...........................................................
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Name and address of each designee.
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Name ................................................................
Address ...........................................................
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2.

The designation of an agent pursuant to chapter 162A of NRS, or the judicial appointment of a guardian, who is authorized to make decisions regarding the withholding or withdrawal of life-sustaining treatment, constitutes for the purpose of NRS 449A.400 to 449A.481, inclusive, a declaration designating another person to act for the declarant pursuant to subsection 1.

Source: Section 449A.439 — Form of declaration designating another person to decide to withhold or withdraw life-sustaining treatment., https://www.­leg.­state.­nv.­us/NRS/NRS-449A.­html#NRS449ASec439.

449A.001
Definitions. 449A.003
“Agency to provide nursing in the home” defined. 449A.005
“Agency to provide personal care services in the home” defined. 449A.007
“Board” defined. 449A.009
“Community-based living arrangement services” defined. 449A.011
“Community health worker” defined. 449A.013
“Community health worker pool” defined. 449A.015
“Community triage center” defined. 449A.017
“Division” defined. 449A.019
“Facility for hospice care” defined. 449A.021
“Facility for intermediate care” defined. 449A.023
“Facility for modified medical detoxification” defined. 449A.025
“Facility for refractive surgery” defined. 449A.027
“Facility for skilled nursing” defined. 449A.029
“Facility for the care of adults during the day” defined. 449A.031
“Facility for the dependent” defined. 449A.033
“Facility for the treatment of alcohol or other substance use disorders” defined. 449A.035
“Facility for the treatment of irreversible renal disease” defined. 449A.037
“Facility for transitional living for released offenders” defined. 449A.039
“Halfway house for persons recovering from alcohol or other substance use disorders” defined. 449A.041
“Home for individual residential care” defined. 449A.043
“Hospice care” defined. 449A.045
“Hospital” defined. 449A.047
“Independent center for emergency medical care” defined. 449A.050
“Medical facility” defined. 449A.052
“Mobile unit” defined. 449A.054
“Nursing pool” defined. 449A.056
“Obstetric center” defined. 449A.058
“Palliative services” defined. 449A.060
“Peer support recovery organization” defined. 449A.062
“Peer support services” defined. 449A.064
“Provider of health care” defined. 449A.066
“Provider of supported living arrangement services” defined. 449A.068
“Psychiatric hospital” defined. 449A.071
“Registered nurse” defined. 449A.073
“Residential facility for groups” defined. 449A.075
“Rural clinic” defined. 449A.077
“Supported living arrangement services” defined. 449A.079
“Surgical center for ambulatory patients” defined. 449A.081
“Terminally ill” defined. 449A.100
Facility to provide necessary services or arrange for transfer of patient 449A.103
Facility to forward medical records upon certain transfers of patient. 449A.106
Specific rights: Information concerning facility 449A.109
Specific rights: Designation of persons authorized to visit patient in facility. 449A.112
Specific rights: Care 449A.114
Certain facilities to notify patient and State Long-Term Care Ombudsman of intent to transfer patient and provide opportunity for patient or representative to meet with administrator 449A.115
Owner and administrator of certain facility prohibited from receiving certain money or property from resident or former resident 449A.118
Patient to be informed of rights upon admission to facility 449A.121
Procedure to insert implant in breast of patient: Informed consent required 449A.124
Procedure to insert implant in breast of patient: Contents of explanation form and consent form 449A.150
Definitions. 449A.153
“Hospital care” defined. 449A.156
“Responsible party” defined. 449A.159
Limitations on efforts of hospitals to collect 449A.162
Limitations on efforts of hospital to collect when hospital has contractual agreement with third party that provides health coverage for care provided 449A.165
Manner of collection. 449A.200
Definitions. 449A.203
“Aversive intervention” defined. 449A.206
“Chemical restraint” defined. 449A.209
“Corporal punishment” defined. 449A.212
“Electric shock” defined. 449A.215
“Emergency” defined. 449A.218
“Facility” defined. 449A.221
“Mechanical restraint” defined. 449A.224
“Person with a disability” defined. 449A.227
“Physical restraint” defined. 449A.230
“Verbal and mental abuse” defined. 449A.233
Aversive intervention: Prohibition on use. 449A.236
Forms of restraint: Restrictions on use. 449A.239
Physical restraint: Permissible use 449A.242
Mechanical restraint: Permissible use 449A.245
Chemical restraint: Permissible use 449A.248
Authorized use of certain forms of restraint by certain facilities. 449A.251
Education and training of members of staff of facility. 449A.254
Violations: Criminal penalties 449A.257
Violations: Report required 449A.260
Prohibition on retaliation against person for reporting or providing information regarding violation. 449A.263
Entry of denial of rights in patient’s record 449A.300
Definitions. 449A.303
“Aftercare” defined. 449A.306
“Caregiver” defined. 449A.309
“Representative of the patient” defined. 449A.312
Designation of caregiver for a patient, removal of designation and designation of new caregiver under certain circumstances 449A.315
Hospital to provide opportunity to designate caregiver for patient before discharge or when patient regains competence. 449A.318
Hospital to record designation or change of caregiver and request consent to release medical information to caregiver if required 449A.321
Hospital to attempt to notify caregiver before planned discharge or transfer of patient. 449A.324
Hospital to attempt to provide caregiver with discharge plan 449A.327
Hospital to document certain actions and instructions in medical record of patient 449A.330
Hospital and employees and contractors of hospital not liable for aftercare provided improperly or not provided by caregiver. 449A.400
Short title 449A.403
Definitions. 449A.406
“Advanced practice registered nurse” defined. 449A.409
“Attending advanced practice registered nurse” defined. 449A.412
“Attending physician” defined. 449A.415
“Declaration” defined. 449A.418
“Life-sustaining treatment” defined. 449A.421
“Person” defined. 449A.424
“Provider of health care” defined. 449A.427
“Qualified patient” defined. 449A.430
“Terminal condition” defined. 449A.433
Declaration relating to use of life-sustaining treatment. 449A.436
Form of declaration directing physician or advanced practice registered nurse to withhold or withdraw life-sustaining treatment. 449A.439
Form of declaration designating another person to decide to withhold or withdraw life-sustaining treatment. 449A.442
Time declaration becomes operative 449A.445
Revocation of declaration 449A.448
Recording determination of terminal condition and declaration. 449A.451
Treatment of qualified patients 449A.454
Written consent to withhold or withdraw life-sustaining treatment. 449A.457
Transfer of care of declarant. 449A.460
Immunity from civil and criminal liability and discipline for unprofessional conduct. 449A.463
Consideration of declaration and other factors 449A.466
Assumption of validity of declaration 449A.469
Death does not constitute suicide or homicide 449A.472
Penalties. 449A.475
Actions contrary to reasonable medical standards not required 449A.478
Other right or responsibility regarding use of life-sustaining treatment or withholding or withdrawal of medical care not limited. 449A.481
Validity of declaration executed in another state 449A.500
Definitions. 449A.503
“Advanced practice registered nurse” defined. 449A.506
“Attending advanced practice registered nurse” defined. 449A.509
“Attending physician” defined. 449A.512
“Attending physician assistant” defined. 449A.515
“Do-not-resuscitate identification” defined. 449A.518
“Do-not-resuscitate order” defined. 449A.521
“Emergency care” defined. 449A.524
“Health care facility” defined. 449A.527
“Life-resuscitating treatment” defined. 449A.530
“Life-sustaining treatment” defined. 449A.533
“Other types of advance directives” defined. 449A.536
“Physician assistant” defined. 449A.539
“Provider of health care” defined. 449A.542
“Provider Order for Life-Sustaining Treatment form” or “POLST form” defined. 449A.545
“Representative of the patient” defined. 449A.548
Board to prescribe standardized POLST form 449A.551
Explanation of POLST form to patient 449A.554
Revocation of POLST form 449A.557
Conflict with other advance directive or do-not-resuscitate identification. 449A.560
Immunity from civil and criminal liability and from discipline for unprofessional conduct. 449A.563
Provider of health care required to comply with valid POLST form 449A.566
Assumption of validity of POLST form 449A.569
Death does not constitute suicide or homicide 449A.572
Unlawful acts 449A.575
Actions contrary to reasonable medical standards not required 449A.578
Validity of POLST form executed in another state. 449A.581
Regulations. 449A.600
Definitions. 449A.603
“Advance directive for psychiatric care” or “advance directive” defined. 449A.606
“Attending physician” defined. 449A.609
“Principal” defined. 449A.612
“Provider of health care” defined. 449A.615
“Psychiatric care” defined. 449A.618
Execution of advance directive 449A.621
Form. 449A.624
Requirements for advance directive to become operative 449A.627
No presumption concerning intention of person without advance directive. 449A.630
Provider to make advance directive part of principal’s medical record. 449A.633
Revocation. 449A.636
Provider to comply with advance directive 449A.639
Transfer of care of principal. 449A.642
Provider to inquire whether person has advance directive for psychiatric care 449A.645
Validity of advance directive executed in another state or instrument executed before May 26, 2017. 449A.700
Definitions. 449A.703
“Advance directive” defined. 449A.706
“Registrant” defined. 449A.709
“Registry” defined. 449A.712
Establishment and maintenance 449A.715
Registration of advance directive: Requirements 449A.718
Access to advance directive. 449A.721
Removal of advance directive of deceased registrant. 449A.724
Secretary of State not required to determine accuracy of contents of advance directive or validity of advance directive 449A.727
Provider of health care not required to inquire whether patient has registered advance directive or access Registry 449A.730
Immunity of Secretary of State and deputies, employees and attorneys of Secretary of State. 449A.733
Suspension of components of Registry and duties of Secretary of State if sufficient money not available 449A.736
Deposit, accounting and use of money received 449A.739
Regulations.
Last Updated

Feb. 5, 2021

§ 449A.439’s source at nv​.us