Nevada Medical Power of Attorney Form

795 Downloads

The Nevada Medical Power of Attorney is a written understanding to legally endow an individual with control over another’s medical decision-making. The durable agreement essentially instates the granted powers upon the principal becoming incapacitated, rendering them unable to communicate their desired course of action. Although a portion of this document allows the declarant to indicate some predetermined treatment preferences, utilizing the Nevada Advance Directive form will provide a more thorough evaluation.

Registering a Medical Power of Attorney in NV

Nevada Lockbox is Nevada’s governmental electronic database used to establish and safeguard medical powers of attorney, living wills, advanced directives, and POLST. Each of these forms must be delivered to the state for approval with the necessary registration paperwork to put the arrangement(s) into effect.

Step 1 – Complete the Medical Power of Attorney Form

Enter the information requested within the medical POA on the principal, designated agent, alternate agents, duration, and limitations. Supply endorsements in the provided spaces with the aid of either a notary or two (2) acceptable witnessing parties.

Step 2 – Complete the Advance Registration Agreement Form

Download the Advance Directive Registration Agreement form and fill out the paperwork as directed. Sign in the specified areas and attach the form to the medical POA.

Step 3 – Submit All Forms to the Secretary of State

Once all the documents are finalized, prepare them for submission by employing one of the following methods:

By Mail:
Nevada Lockbox
c/o Nevada Secretary of State Barbara K. Cegavske
2250 Las Vegas Blvd. North, Suite 400
North Las Vegas, NV 89030

OR

By Fax:

(775) 684-7177

The secretary of state’s office may take up to ten (10) full business days to accept and upload the agreement to the system. A wallet card will be issued to the principal by mail, along with instructions for online access to the document(s).

Other Versions (4)

Carson Tahoe Regional Health Care Version

Download: Adobe PDF

 

 

 


Nevada Aging and Disability Services Division Version

Download: Adobe PDF

 

 

 


South Lyon Medical Center Version

Download: Adobe PDF
Information: Adobe PDF

 

 


Spanish Version

Download: Adobe PDF

 

 

 

Additional Resources

Related Forms (7)

Advance Directive (Medical POA & Living Will)

Download: Adobe PDF

 

 

 


Advance Directive for Psychiatric Care

Download: Adobe PDF

 

 

 


Advance Directive Registration Agreement

Download: Adobe PDF

 

 

 


Advance Directive Wallet Card

Download: Adobe PDF

 

 

 


Durable (Financial) Power of Attorney

Download: Adobe PDF

 

 

 


Do-Not-Resuscitation (DNR) Identification Application – Adult Form (also available for a Minor)

Download: Adobe PDF
Instructions: Adobe PDF

 

 


Provider Order for Life-Sustaining Treatment (POLST) (also available in Spanish/en Español)

Download: Adobe PDF