DURABLE POWER OF ATTORNEY FOR HEALTH CARE DECISIONS

(State of Nevada)

[// GUIDANCE: This template is drafted to comply with Nevada’s Uniform Power of Attorney for Health Care Decisions, NEV. REV. STAT. §§ 162A.760–162A.870 (2023), and includes a HIPAA release pursuant to 45 C.F.R. § 164.502(g). Customize bracketed fields before execution. Where options are presented, delete inapplicable text. Practitioners should confirm that the final document comports with the Principal’s wishes and the most current statutory requirements.]

TABLE OF CONTENTS

I. Document Header
II. Definitions
III. Operative Provisions
    A. Appointment of Agent
    B. Alternate Agent(s)
    C. Grant of Authority
    D. End-of-Life Instructions
    E. HIPAA Authorization
    F. Nomination of Guardian
IV. Representations & Warranties
V. Covenants & Restrictions
VI. Default & Remedies
VII. Risk Allocation
VIII. Dispute Resolution
IX. General Provisions
X. Execution Block

I. DOCUMENT HEADER

1. Title. Durable Power of Attorney for Health Care Decisions (the “Power of Attorney” or “POA”).
2. Parties.
   a. “Principal”: [PRINCIPAL LEGAL NAME], residing at [PRINCIPAL ADDRESS].
   b. “Agent”: [AGENT LEGAL NAME], residing at [AGENT ADDRESS].
3. Effective Date. This POA becomes effective:
   [ ] Immediately upon execution.
   [ ] Upon a determination of incapacity as defined in Section II below.
4. Governing Law. This POA shall be governed by and construed in accordance with the health-care powers of attorney provisions of the Nevada Revised Statutes and other applicable Nevada law (“State Healthcare Law”).

II. DEFINITIONS

For purposes of this POA and any attachments:

“Advance Directive” – Any written instrument, including this POA, that expresses the Principal’s wishes regarding health-care decisions.

“Agent” – The individual designated in Section III.A (or any Successor Agent) who is authorized to make Health-Care Decisions on behalf of the Principal.

“Good Faith” – Honesty in fact and the observance of reasonable health-care standards consistent with NEV. REV. STAT. § 162A.865(2).

“Health-Care Decision” – Any decision to consent, refuse consent, withdraw consent, or request withholding of health care, treatment, service or diagnostic procedure, including decisions relating to life-sustaining treatment and organ donation.

“HIPAA” – The Health Insurance Portability and Accountability Act of 1996 and its implementing regulations, including 45 C.F.R. parts 160–64.

“Incapacity” – The inability to receive and evaluate information or communicate decisions to such an extent that the individual lacks the ability to meet essential requirements for physical health, safety, or self-care, as certified in writing by a licensed physician or, if permitted, an advanced practice registered nurse.

“Life-Sustaining Treatment” – Any medical procedure or intervention that, when administered to a person in a terminal condition, serves only to prolong the process of dying.

“Principal” – The individual granting power hereunder, identified in Section I.2.a.

“State Probate Court” – The district court of competent jurisdiction for probate matters in the county where the Principal resides or is located at the time of filing.

III. OPERATIVE PROVISIONS

A. Appointment of Agent

1. Designation. The Principal hereby designates [AGENT LEGAL NAME] as Agent to make Health-Care Decisions on the Principal’s behalf, subject to the terms of this POA.
2. Acceptance. By signing below, the Agent accepts the appointment and agrees to act in Good Faith and in accordance with the Principal’s wishes and best interests.

B. Alternate Agent(s)

If the Agent is unavailable, unwilling, or unable to act, the following individuals shall serve successively (each a “Successor Agent”):
1. First Alternate: [ALTERNATE 1 NAME]
2. Second Alternate: [ALTERNATE 2 NAME]

C. Grant of Authority

1. Scope. The Agent is authorized to make all Health-Care Decisions for the Principal that the Principal could make personally, including but not limited to:
   a. Consent to, refuse, or withdraw any medical treatment;
   b. Admit or discharge the Principal from any health-care facility;
   c. Hire and discharge health-care providers;
   d. Have access to medical records and information; and
   e. Authorize autopsy, organ donation, and disposition of remains, subject to Section III.D.
2. Limitations. Any express limitations stated in Section V or elsewhere herein shall control. The Agent may not:
   a. Voluntarily euthanize or mercy-kill the Principal;
   b. Consent to psychosurgery or involuntary commitment unless explicitly authorized below;
   c. Act in conflict with the Principal’s documented Advance Directives.

D. End-of-Life Instructions

[// GUIDANCE: Tailor the following options.]
1. Terminal Condition. If I am in a terminal condition and cannot communicate my wishes, I direct my Agent as follows:
[ ] I want life-sustaining treatment continued.
[ ] I do NOT want life-sustaining treatment if it only prolongs the dying process.
2. Persistent Vegetative State.
[ ] Provide artificial nutrition and hydration.
[ ] Withhold/withdraw artificial nutrition and hydration.
3. Pain Relief. I authorize maximum pain relief, even if it may hasten death, provided it is not the intentional cause of death.
4. Do-Not-Resuscitate (DNR). [ ] I have executed a separate DNR order. [ ] I have NOT executed a DNR order.

E. HIPAA Authorization

Pursuant to 45 C.F.R. § 164.502(g), the Agent (and any Successor Agent) is designated as the Principal’s “personal representative” for all purposes under HIPAA and is authorized to obtain, use, and disclose protected health information as necessary to carry out the powers granted herein. This authorization is effective immediately and survives the Principal’s death to the extent permitted by law.

F. Nomination of Guardian

If a court determines that a guardian, conservator, or other fiduciary must be appointed, the Principal nominates the Agent (or the first available Successor Agent) to serve as such fiduciary.

IV. REPRESENTATIONS & WARRANTIES

1. Principal’s Capacity. The Principal affirms that, as of the execution date, he or she is of sound mind and under no duress or undue influence.
2. No Conflicts. The Principal warrants that any prior health-care power of attorney is revoked or will be revoked concurrently with the execution of this POA.
3. Agent Eligibility. The Agent represents that he or she is not currently the Principal’s health-care provider or an operator/employee of a health-care facility in which the Principal resides, except as permitted under NEV. REV. STAT. § 162A.860(2).

V. COVENANTS & RESTRICTIONS

1. Standard of Conduct. The Agent shall:
   a. Act in Good Faith;
   b. Follow the Principal’s known instructions;
   c. Act in the Principal’s best interests when instructions are unknown.
2. Consultation. The Agent shall consult with the Principal’s physicians and other professionals as appropriate.
3. Record-Keeping. Upon request of any interested person or court, the Agent shall provide an accounting of actions taken under this POA.
4. Non-Delegation. The Agent may not delegate authority granted herein without written consent of the Principal (if competent) or court order.

VI. DEFAULT & REMEDIES

1. Removal of Agent. An interested person may petition the State Probate Court to remove or replace the Agent for breach of fiduciary duty, incapacity, or other good cause.
2. Ratification. Health-care providers acting in reliance on this POA are protected under NEV. REV. STAT. § 162A.840 and shall not incur civil or criminal liability for such reliance.
3. Attorney’s Fees. In any judicial proceeding arising from this POA, the prevailing party shall be entitled to reasonable attorneys’ fees and costs, in the court’s discretion.

VII. RISK ALLOCATION

1. Indemnification. The Principal agrees to indemnify and hold the Agent harmless from any liability arising from Good-Faith actions under this POA (“agent_good_faith”), except for willful misconduct or gross negligence.
2. Limitation of Liability. In no event shall the Agent be liable for consequential, punitive, or exemplary damages so long as the Agent acts in Good Faith (“good_faith_standard”).
3. Insurance. [OPTIONAL] The Principal may, but is not required to, maintain liability insurance for the Agent’s benefit.
4. Force Majeure. The Agent shall not be liable for failure to act when prevented by events beyond the Agent’s reasonable control, including natural disasters, war, terrorism, or widespread epidemics.

VIII. DISPUTE RESOLUTION

1. Governing Law. This POA is governed by “State Healthcare Law” as defined in Section I.4.
2. Forum Selection. Any action or proceeding arising under this POA shall be brought exclusively in the State Probate Court of [COUNTY], Nevada.
3. Arbitration. Arbitration is NOT available for disputes under this POA.
4. Jury Waiver. The parties do NOT waive the right to a jury trial.
5. Injunctive Relief. Nothing herein limits any party’s right to seek injunctive or declaratory relief to enforce a health-care directive.

IX. GENERAL PROVISIONS

1. Revocation. This POA may be revoked at any time by (a) a signed written instrument by the Principal, or (b) oral expression of intent to revoke in the presence of a witness 18 years or older who subsequently signs a written confirmation.
2. Amendment. May be amended only by a writing executed with the same formalities as this POA.
3. Severability. If any provision is held unenforceable, the remaining provisions shall remain in full force.
4. Integration. This POA constitutes the entire agreement regarding the subject matter and supersedes all prior directives to the extent of any conflict.
5. Counterparts; Electronic Signatures. This POA may be executed in counterparts and by electronic signature, each of which shall be deemed an original.
6. Delivery. Photocopies, facsimiles, and electronically transmitted counterparts shall have the same legal effect as an original.

X. EXECUTION BLOCK

[// GUIDANCE: Nevada permits EITHER two qualified witnesses OR notarization. Choose ONE method and strike the other.]

A. Principal’s Signature

I, [PRINCIPAL LEGAL NAME], the Principal, sign my name to this Durable Power of Attorney for Health Care Decisions on this ___ day of ____, 20__, at [CITY], Nevada.

[PRINCIPAL LEGAL NAME], Principal

B-1. Witness Attestation (if executed before witnesses)

Each witness declares under penalty of perjury that (a) the Principal is personally known or has provided satisfactory proof of identity, (b) the Principal signed or acknowledged this POA in the witness’s presence, (c) the witness is not the Agent, a Successor Agent, the Principal’s health-care provider, or an employee of such provider, and (d) the witness is not entitled to any portion of the Principal’s estate.

Witness #1

Name: [PRINT]
Address: ___
Date: ______

Witness #2

Name: [PRINT]
Address: ___
Date: ______

[// GUIDANCE: Delete Section B-2 if using witnesses.]

B-2. Notary Acknowledgment (if executed before a notary)

State of Nevada )
County of ______ )

On this ___ day of ____, 20__, before me, the undersigned notary public, personally appeared [PRINCIPAL LEGAL NAME], known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he or she executed the same for the purposes herein contained.

In witness whereof I hereunto set my hand and affixed my official seal.

Notary Public
My commission expires: ____

C. Agent’s (and Successor Agent’s) Acceptance

I hereby accept the appointment as Agent (or Successor Agent) and agree to exercise the powers and duties described herein.

1. Agent:

[AGENT LEGAL NAME]
Date: ______

2. First Alternate Agent:

[ALTERNATE 1 NAME]
Date: ______

3. Second Alternate Agent:

[ALTERNATE 2 NAME]
Date: ______

[// GUIDANCE: Provide executed copies to (1) each Agent, (2) the Principal’s primary physician, and (3) any healthcare facility where the Principal receives ongoing treatment. Retain the original in a secure yet accessible location.]