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Nevada Living Will Form |
The Nevada living will is a legal document that is prepared by a person (Principal) who would like to prepare a document in advance for the purpose of informing medical providers, family and any other interested parties of the decisions the Principal has made to possibly withdraw treatment in the event they are no longer mentally capable to make their own medical decisions due to their condition as they circumstances that may end their life. The document must be completed by the Principal. The Principal must be of sound mind. The document may also be revoked at any time should the Principal feel necessary.
Laws – Nevada Revised Statutes Sections 449.535 to 449.690 – Uniform Act on Rights of the Terminally Ill
How to Write
Step 1 – The Principal must download the document and carefully read the paragraph at the top of the page, if in agreement, proceed to:
- Initial one of the two statements below the paragraph, that would best reflect the decision of the Principal
- Date the Principal’s signature in dd/mm/yyyy format
- Principal must provide their signature
- Principal’s Complete Address
Witnesses – Witnesses must read the statement. If in agreement:
- Witnesses respective signatures
- Complete addresses
Step 2 – Nevada Durable Power of Attorney for Healthcare – If the Principal would like to establish a health care agent to make health care decisions when they are no longer able to do so on their own – Enter:
- The name of the Principal
- AND
- Name of the appointed agent
- Address
- Telephone Number
Step 3 – Titled Sections – Review –
- Creation of Durable Power of Attorney for Healthcare
- General Statement of Authority Granted
- Special Provisions and Limitations – If the Principal would like to document other provisions, limitations and/or restriction, enter them into the box provided
- Duration- If there will be an expiration date prior to death, enter the date in mm/dd/yyyy format
- Statement of Desires – The Principal must read this section and initial all statements that are applicable – If there are other statements of desires not listed, enter them into the box provided
Step 4 – Designation of Alternate Agent – If the Principal would like to appoint a second agent, (the principal may enter up to two additional alternates to serve consecutively) in the event the initial agent is unable or unwilling to serve. Enter the following information:
- Provide the name of each agent
- Addresses
- Telephone numbers
Step 5 – Prior Designations Revoked – If the Principal would like to make changes or completely revoke the document provide the following:
- Date in mm/dd/yyyy format
- City of residence
- State of residence
- Principal’s signature
Step 6 – Notary Acknowledgement or Witness Signatures – The Principal may select one or the other – If selecting a notary acknowledgement:
- The notary public, must witness the Principal’s signature
- The Notary will then complete all required information,
- The notary shall provide signature and affix the notary seal
- OR
Witnesses – The witnesses must read the witness statements. If in agreement provide:
- Witness signatures
- Printed names
- Date of signatures mm/dd/yyyy format
- Residential address
Provide copies of this completed document to your health care provider and your agent.
