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Nevada Living Will Form

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Nevada Living Will Form

Updated August 03, 2023

A Nevada living will, or “declaration,” is a brief form clearly stating the Declarant’s wishes in end-of-life situations. It references that the patient would not wish to seek artificial treatment options if they should check the appropriate box and sign. This form should be filed with their physician and/or family including close friends.


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(1) Intent To Refuse Medical Care. The State of Nevada will allow terminally ill Patients or those with untreatable/incurable medical conditions the right to opt-out of life support treatments whose only purpose is to keep the body alive without a cure or hope of recovery. Oftentimes, this only postpones death. If a Nevada Patient is incapacitated or permanently unconscious at the time of a fatal diagnosis, however, then only a living will or duly appointed Health Care Agent can effectively communicate a Nevada Patient’s decision to refuse the use of life support measures and procedures. To use this document to communicate the desire to refuse life support when it is needed to live during an incurable medical condition, locate the checkbox presented near the declaration, then submit your initials to its content. This will inform Nevada Physicians not to artificially prolong your life when no cure or chance for recovery from your medical condition is available.

Nevada Declarant Signature Requirement

(2) Signature Date. Nevada Physicians will require proof that the document above originated from you and bears your intention accurately. Thus, a signature that is both dated and verifiable must be delivered. When you are ready to execute this medical directive in Nevada, locate the signature area displayed then record the current date.

(3) Executing Signature. Immediately after recording the current date, sign your full name where it is requested. Only perform this act as two adult Witnesses watch you.

(4) Declarant Address. As the Nevada Patient or Declarant, Physicians will wish to confirm your identity before applying this document to your treatment decisions. Provide your address as an aid to this confirmation. After completing the signature area, release this paperwork to the Witnesses in attendance.

Nevada Witness Signature Requirement

(5) Witness A Signature And Address. Witness A must sign his or her name as well as document a residential address where he or she can be reached in the future. Bear in mind, the Witnesses may only sign this document after watching you sign your name.

(6) Witness B Signature And Address. Witness B is also required to sign this document and present his or her address. Once Witness B has completed this action, the living will portion of this package can be considered complete.

(7) Proof Of Review. Initial the completed page once it has been completed to display your approval of its content. This will be necessary for every page of the next portion of this document should you choose to continue.

Letter To Loved OnesComfort And Dignity

(8) Pain Management. The next portion of this package can be considered a basic letter regarding your end-of-life preferences. While this will not be considered a legal document, it will carry some weight since it will bear your signature. These preferences can be delivered to your Loved Ones easily by simply reviewing the statements made then initialing each request or message that you wish to adopt. For instance, by initialing Item A, B, and/or C, you will be able to inform Reviewers of this letter that you wish to receive medical treatment for pain, that you wish your body temperature maintained, and/or that you wish your mouth/lips kept moist.

(9) Basic Hygiene Request. You can request that Loved Ones reviewing this document try to keep you clean at all times by initialing Item D.

(10) Comfort And Grooming Request. Additional care requests can be made through this letter by initialing Item E and/or Item F. This will inform Loved Ones that you wish to have oils and massage employed to keep your skin healthy and/or that your grooming habits are maintained.

(11) Need For Support. This letter enables additional appeals for personal support. If you wish your Loved Ones to visit you often when suffering an end-of-life event, be spoken to even if unconscious, and deliver physical encouragement such as holding your hands or hugging you then review and initial the appropriate statements made in Items A, B, and C.

(12) Spiritual And Emotional Support. You can continue making more personal requests of your Loved Ones such as asking that your Spiritual Community is informed of your condition, that Visitors are encouraged to remain positive when in your presence, and that the room where you are receiving medical care contain items your Loved Ones believe you to be attached to (i.e. photographs). Items D, E, and F will allow you to make one or all of these requests so long as you initial each statement that you wish to make.

(13) Environment Preferences. To request that all linens (including clothing) be kept clean while you are incapacitated with a terminal condition, you must initial Item G.

(14) End-Of-Life Location. If you have decided that you wish to be able to die in your home (if possible), then initial Item H. Furthermore, you may request that your favorite television broadcasts be arranged regardless of your location by initialing Item I.

(15) Outdoor Activities. When close to death, you may not be as mobile as you were while healthy. You may request that your Loved Ones take you outdoors when possible, for your normally preferred activities, by initialing Item J.

(16) Music. Initial Item K if you wish to request that your favorite pieces of music be played to you whenever this is possible.

(17) Religion. It is likely your Loved Ones are abreast of your religious preferences. If so, and you wish certain (religious) passages read to you, initial Item L.

(18) Poems. Initial Item M to request that poetry be read while you are terminally ill even if you seem unresponsive.

(19) Delivering Important Messages. The previous issues focused on requests you can make on the intended Recipient(s) to aid in your comfort and end-of-life care. The next section enables you to deliver additional and more personal messages. Initial Item 1 to inform the Recipient that you love him or her.

(20) Forgiveness. The second item will enable you to request the Letter Recipient forgives you for any past wrongs while the third item informs the Letter Recipient that you forgive him or her. Initial one or both of these items to deliver such a message to the Loved One reading this letter.

(21) Acceptance Of Death. If you wish to reassure your Loved Ones that you do not fear death, then initial and initial Item 4.

(22) Social Request. Item 5 makes a public request that your family becomes closer reconfirming their love for one another.

(23) Request For Remembrance. If you specifically wish your Loved Ones to know that you wish to be remembered before you were stricken with a fatal condition then, you must initial Item 6.

(24) Self-Improvement. Item 7 will request that those around you honor your memory by seeking a better life or outlook. Initial this item to submit this request to Reviewers of your letter.

(25) Support Approval. You may encourage your Loved ones to seek emotional support through counseling to better deal with your death if needed by initialing Item 8.


(26) Legacy Preference. Space has been made available to enable you to present exactly how you wish to be remembered. This will be useful for any funeral services that follow.

(27) Memorial Representative.  If one or more people have been made aware of your funeral preferences, make sure to use the appropriate area to identify each one by name and his or her contact information.

(28) Memorial Request. You may use the next two areas to inform Reviewers of your memorial preferences and any other personal requests you wish made during your end-of-life experience.

(29) Signature Date. As mentioned earlier, the letter you have completed is optional and will not necessarily constitute a document with any medical instruction powers. However, it can aid those around you with your death and may even provide some insight to your end-of-life preferences and decisions. To make this letter official, you must provide a dated signature, thus locate the final statement. Record the current calendar date.

(30) Signature. Sign your name to close this letter properly.

(31) Printed Name. Print your name to clearly identify yourself as this letter’s author.

(32) Review And Show Approval. If you have not done so already, review each page, then deliver your initials of approval to the bottom as a display that you approve of its content.