Nevada Living Will Template
This Nevada Living Will Template is designed to help you communicate your wishes regarding medical treatment in the event that you are unable to do so yourself. It is guided by the Nevada Life-Sustaining Treatment Decisions Act, ensuring that your rights and preferences are respected and upheld in accordance with state-specific regulations.
Part 1: Personal Information
Full Name: ___________________________________________________________
Date of Birth: _________________________
Address: _____________________________________________________________
City: __________________________ State: NV Zip Code: _________________
Telephone: _________________________
Part 2: Declaration
As a resident of the State of Nevada, I hereby declare my wishes regarding the use, withholding, or withdrawal of life-sustaining treatment in the event that I am diagnosed with a terminal condition or am in a persistent vegetative state from which there is no reasonable expectation of recovery. My decisions are based on my personal values and beliefs, and this document serves as evidence of those decisions.
Part 3: Treatment Preferences
- Life-Sustaining Treatment
In the situation where I am unable to make my own health care decisions and am determined to be in a terminal condition or in a persistent vegetative state, my preference regarding life-sustaining treatment is as follows:
- ______ I wish to receive all forms of life-sustaining treatment and interventions, including resuscitation.
- ______ I wish to withhold or withdraw life-sustaining treatments, understanding that this decision may hasten my death.
- Artificial Nutrition and Hydration
My preference regarding the provision of artificially administered nutrition (feeding tube) and hydration (IV fluids) is:
- ______ I wish to receive artificially administered nutrition and hydration regardless of my condition.
- ______ I wish to withhold or withdraw artificially administered nutrition and hydration, understanding that this decision may hasten my death.
- Other Instructions
You may provide any specific instructions or limitations you deem important regarding your health care treatment here:
______________________________________________________________________________
______________________________________________________________________________
Part 4: Signature
This Living Will shall be considered valid and enforceable in the State of Nevada. By signing below, I affirm that I am of sound mind and I understand the contents of this document. This document expresses my legal and medical preferences.
Signature: _______________________________ Date: _________________________
Print Name: ___________________________________________________________
Part 5: Witness Declaration
I, ___________________________________________, declare that the individual who signed this document in my presence did so voluntarily and appeared to be of sound mind and under no duress, fraud, or undue influence.
Witness Signature: _______________________________ Date: _________________________
Print Name: ____________________________________________________________
Please note, it is recommended to review this living will periodically and after any significant life events or changes in health status.