Living Will / Advance Directive

Living Will / Advance Directive

Provide your information and preferences to help prepare your Nevada-compliant Living Will / Advance Directive. This form is not legal advice.
NRS240A Disclaimer - Read Carefully.

I, DEBORAH BARNHART, DOING BUSINESS AS DPSOFNORTHERN NEVADA, AM NOT AN ATTORNEY IN THE STATE OF NEVADA. I AM NOTAUTHORIZED TO GIVE LEGAL ADVICE OR LEGAL REPRESENTATION. I MAY NOTACCEPT FEES FOR GIVING LEGAL ADVICE OR LEGAL REPRESENTATION.
Personal Information

Please enter your full legal name and contact details.
Full Legal Name*

First NameMiddle NameLast NameSuffix
Date of Birth*

MonthDayYear
Date
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Appointment of Health Care Agent

Designate your primary health care agent.
Primary Health Care Agent's Full Name*

First NameMiddle NameLast NameSuffix
Relationship to You (Primary Agent)*
Primary Agent's Phone Number*
Please enter a valid phone number.
Primary Agent's Email Address
example@example.com
Alternate Health Care Agent(s)

You may designate one or more alternate agents.
Alternate Agent's Full Name

First NameMiddle NameLast NameSuffix
Relationship to You (Alternate Agent)
Alternate Agent's Phone Number
Please enter a valid phone number.
Alternate Agent's Email Address
example@example.com
End-of-Life Treatment Preferences

Indicate your preferences regarding life-sustaining treatments.
If I am terminally ill or in a persistent vegetative state, I want the following life-sustaining treatments (select all that apply):*

CPR (Cardiopulmonary Resuscitation)Mechanical VentilationArtificial Nutrition (feeding tube)Artificial Hydration (IV fluids)Comfort Care Only (no life-sustaining treatment)Other (please specify)
If you selected 'Other', please specify your preference:
Terminal Condition and Persistent Vegetative State Preferences

Specify your wishes regarding treatment if you are terminally ill or in a persistent vegetative state.
If I am diagnosed with a terminal condition or persistent vegetative state, my preference is:*

Continue all life-sustaining treatment until natural deathWithhold or withdraw life-sustaining treatment except for comfort careOther (please specify)
Pain Management and Palliative Care Wishes

Indicate your preferences for pain management and comfort care.
My preference for pain management and palliative care is:*

Provide any pain relief necessary, even if it may hasten deathLimit pain relief to avoid possible unconsciousness or hastening deathOther (please specify)
Organ and Tissue Donation Preferences

Indicate your wishes regarding organ and tissue donation.
Upon my death, I wish to:

Donate any needed organs or tissuesDo not donate any organs or tissuesDonate only specific organs/tissues (please specify)
If you selected 'Donate only specific organs/tissues', please specify:
Religious or Personal Beliefs

Share any religious or personal beliefs that may affect your medical care preferences.
Please describe any religious or personal beliefs that should be considered (optional):
Witness or Notary Requirement

Choose your preferred method for legal witnessing.
I will have this document witnessed by:*

Two adult witnesses (not health care provider/agent)A notary public
Witness Information (if applicable)

Provide details for each witness if you choose two adult witnesses.
Witness #1 Full Name

First NameMiddle NameLast NameSuffix
Witness #1 Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Witness #2 Full Name

First NameMiddle NameLast NameSuffix
Witness #2 Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Optional Uploads

You may upload a copy of any prior advance directives.
Upload prior advance directives (optional)

Cancelof
NRS240A Disclaimer - Read Carefully.

I, DEBORAH BARNHART, DOING BUSINESS AS DPS OF NORTHERN NEVADA, AM NOT AN ATTORNEY IN THE STATE OF NEVADA. I AM NOT AUTHORIZED TO GIVE LEGAL ADVICE OR LEGAL REPRESENTATION. I MAY NOT ACCEPT FEES FOR GIVING LEGAL ADVICE OR LEGAL REPRESENTATION.
I understand that Deborah Barnhart, dba DPS of NorthernNevada, is not an attorney and is acting solely as a legal document preparer.
Name*

First NameMiddle NameLast NameSuffix
Should be Empty:

Living Will / Advance Directive

NRS240A Disclaimer - Read Carefully.

Personal Information

Appointment of Health Care Agent

Alternate Health Care Agent(s)

End-of-Life Treatment Preferences

Terminal Condition and Persistent Vegetative State Preferences

Pain Management and Palliative Care Wishes

Organ and Tissue Donation Preferences

Religious or Personal Beliefs

Witness or Notary Requirement

Witness Information (if applicable)

Optional Uploads

NRS240A Disclaimer - Read Carefully.