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Nevada statutory health care form
Download the August 2026 Nevada Declaration Regarding Life-Sustaining Treatment packet, the optional sample forms under NRS 449A.436 and 449A.439 for terminal-condition life-sustaining treatment directions or a designated decision-maker. Get both forms in editable Word and true fillable PDF. Add the completed sample PDF if you want a filled-in reference.
A state-specific declaration regarding life-sustaining treatment packet, reviewed against the current Nevada statute and ready for instant secure access.
Form A is the direct declaration under NRS 449A.436. Form B designates a decision-maker under NRS 449A.439. Both include the artificial nutrition and hydration initial election.
These declarations address withholding or withdrawal of life-sustaining treatment in a terminal condition. They are not a general health-care power of attorney.
Complete the form on your device, then print, wet-initial any election, and sign with two witnesses. Your personal details are never entered into an online form builder.
This download includes 1 document in editable Word and fillable PDF formats. Use the Word version for editing; the fillable PDF can be completed on screen, then printed and signed.
Review the complete form text below before purchasing. Your licensed download (editable Word and fillable PDF) is delivered after checkout.
NEVADA DECLARATION REGARDING LIFE-SUSTAINING TREATMENT
NRS 449A.436 and 449A.439 sample forms · Chapter 449A
Packet note: Two optional sample declarations under NRS 449A.400 to 449A.481. Form A is the direct declaration (NRS 449A.436). Form B designates a decision-maker (NRS 449A.439). Choose one. Sign before two witnesses (NRS 449A.433). No notary alternative. Not a general health-care power of attorney (see NRS 162A.855).
FORM A: DIRECT DECLARATION (NRS 449A.436)
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 direct my attending physician or attending advanced practice registered nurse, pursuant to NRS 449A.400 to 449A.481, inclusive, to withhold or withdraw treatment that only prolongs the process of dying and is not necessary for my comfort or to alleviate pain.
If you wish to include this statement in this declaration, you must INITIAL the statement in the box provided:
(___) 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.
Signed this ______ day of ____________, ______.
____________________ Signature of Declarant
____________________ Address of Declarant
The declarant voluntarily signed this writing in my presence.
First Witness / Second Witness signature, printed name, and address lines.
FORM B: DESIGNATION OF DECISION-MAKER (NRS 449A.439)
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.
(___) 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.
Signed this ______ day of ____________, ______.
____________________ Signature of Declarant
____________________ Address of Declarant
The declarant voluntarily signed this writing in my presence.
First Witness / Second Witness signature, printed name, and address lines.
Name and address of each designee. Primary name and address. Alternate name and address.
Legal currency, verified
This Nevada packet gives you two optional sample declarations under NRS 449A.400 to 449A.481 for life-sustaining treatment when you have a terminal condition and can no longer decide. Form A is a direct instruction to your attending physician or advanced practice registered nurse. Form B appoints a person to make that same narrow decision for you.
Tracks the optional sample forms in NRS 449A.436 and 449A.439, including attending advanced practice registered nurse language from the 2017 amendments. Verified August 2026 against the official Nevada Revised Statutes. It is not a government publication. A broader advance health-care directive under NRS 162A.855 is a separate product.
Sign the declaration yourself, or have another person sign at your direction, and have two witnesses attest under NRS 449A.433. There is no notary alternative in chapter 449A. Choose Form A or Form B. Complete and sign only one form unless you intentionally want both.
Form A direct declaration (NRS 449A.436), Form B designation declaration (NRS 449A.439) with primary and alternate designee lines, artificial nutrition and hydration initial elections on each form, and two-witness execution blocks. A completed sample PDF is available separately as a filled-in reference.
Editable Word and true fillable PDF of the complete two-form Nevada declaration packet. Customer support and lifetime update access are included with your purchase. The separate Nevada Advance Health-Care Directive under NRS 162A.855 is not included.
This form is not legal advice. Consider speaking with a Nevada licensed attorney about your situation.
ILRG is committed to top quality legal forms that are valid in all states. If you are not 100 percent satisfied after purchase, contact us for a full refund.
Yes. This packet tracks the optional sample declarations in NRS 449A.436 and 449A.439 under chapter 449A. Verified in August 2026 against the official Nevada Revised Statutes. It is not a government publication.
Use Form A if you want a direct instruction to your attending physician or advanced practice registered nurse. Use Form B if you want to appoint a person to make that same narrow life-sustaining treatment decision. Choose one unless you intentionally want both.
You sign, or another person may sign at your direction, and two witnesses must attest under NRS 449A.433. Chapter 449A does not provide a notary alternative.
This chapter 449A packet is limited to terminal-condition life-sustaining treatment directions or a designated decision-maker for that purpose. The separate NRS 162A.855 Advance Health-Care Directive is a broader instrument for general health-care decisions.
Initial the box only if you want to receive or continue receiving artificial nutrition and hydration by way of the gastrointestinal tract after other treatment is withheld. If you do not initial it, that nutrition and hydration is treated as life-sustaining treatment under NRS 449A.451.
Both contain the same Nevada declaration packet. Use the editable Word file to type details, or the fillable PDF to complete fields on screen. Print the finished document, wet-initial any election, and sign on paper before two witnesses.