DO NOT RESUSCITATE (DNR) MEDICAL DIRECTIVE
(Pursuant to Nevada Law – NRS ch. 450B)
[// GUIDANCE: This template is designed to satisfy Nevada‐specific statutory requirements for a Do Not Resuscitate Medical Directive (“Directive”). Customize all bracketed placeholders before execution. Attach any State of Nevada–issued forms or identification (bracelet/necklace) required for Emergency Medical Services (“EMS”) recognition.]
TABLE OF CONTENTS
- Document Header
- Definitions
- Operative Provisions
- Representations & Warranties
- Covenants & Restrictions
- Default & Remedies
- Risk Allocation
- Dispute Resolution
- General Provisions
- Execution Block
1. DOCUMENT HEADER
1.1 Title. DO NOT RESUSCITATE (DNR) MEDICAL DIRECTIVE (“Directive”).
1.2 Parties.
a. “Patient/Declarant”: [PATIENT FULL LEGAL NAME], DOB [MM/DD/YYYY], residing at [ADDRESS].
b. “Attending Physician”: [PHYSICIAN NAME], Nevada License No. [NUMBER], practicing at [ADDRESS].
c. “Health-Care Providers & EMS Personnel”: Any Nevada-licensed health-care facility, practitioner, or EMS agency who, in good faith, relies upon this Directive.
1.3 Effective Date. This Directive is effective on the latest date of signature below (“Effective Date”).
1.4 Governing Law. This Directive is governed by the laws of the State of Nevada, including but not limited to NRS ch. 450B and all regulations promulgated thereunder (“State Health-Care Law”).
2. DEFINITIONS
For purposes of this Directive, capitalized terms have the meanings set forth below. Terms not defined herein have the meanings given under applicable Nevada statutes and regulations.
“Attending Physician” – The Nevada-licensed physician who has primary responsibility for the Patient’s medical care and who signs this Directive.
“DNR Identification” – A State of Nevada-approved bracelet, necklace, or other form of identification evidencing this Directive pursuant to NRS ch. 450B.
“EMS Personnel” – Personnel licensed or certified under NRS ch. 450B to provide emergency medical services, including, without limitation, paramedics, advanced EMTs, EMTs, and ambulance attendants.
“Good Faith” – Honesty in fact and the reasonable belief that the Directive is valid and has not been revoked.
“Resuscitative Measures” – Cardiopulmonary resuscitation (CPR), advanced cardiac life support (ACLS), defibrillation, intubation solely for the purpose of resuscitation, positive-pressure ventilation, administration of vasoactive drugs for resuscitation, or any other similar lifesaving interventions.
“Witness” – An adult natural person who satisfies the requirements of Section 10.3 and is not otherwise disqualified under Nevada law.
3. OPERATIVE PROVISIONS
3.1 Directive to Withhold Resuscitation. The Patient expressly directs that no Resuscitative Measures be attempted in the event of cardiac or respiratory arrest.
3.2 Scope of Medical Treatment.
a. This Directive applies solely to Resuscitative Measures.
b. The Patient DOES consent to all comfort care, pain management, and other medically indicated interventions that do not constitute Resuscitative Measures, unless otherwise specified here: [ADDITIONAL INSTRUCTIONS / “NONE”].
3.3 EMS Recognition. EMS Personnel in Nevada shall honor this Directive and any DNR Identification presented, consistent with NRS ch. 450B and applicable Nevada Administrative Code provisions.
3.4 Conditions Precedent. This Directive is effective only when:
i. All signature and witness requirements are satisfied; and
ii. EMS Personnel or other Health-Care Providers have actual notice of the Directive or the Patient is wearing approved DNR Identification.
3.5 Revocation & Modification.
a. The Patient may revoke this Directive at any time by oral or written expression or by destroying this document and any DNR Identification.
b. Revocation is effective upon communication to any Health-Care Provider.
c. Any modification must be executed with the same formality as this Directive.
3.6 Duplicate Originals & Copies. A photocopy, facsimile, or electronic copy of this Directive, including images of the Patient’s DNR Identification, shall have the same force and effect as an original.
4. REPRESENTATIONS & WARRANTIES
4.1 Patient Representations. The Patient represents and warrants that:
a. The Patient is of sound mind, at least 18 years of age (or an emancipated minor), and acting voluntarily without duress or undue influence;
b. The Patient has been informed of the medical consequences of executing this Directive; and
c. No prior directive remains in effect that conflicts with this Directive.
4.2 Physician Representations. The Attending Physician represents and warrants that:
a. The Physician has discussed Resuscitative Measures and alternatives with the Patient (or the Patient’s legally authorized representative);
b. The Patient has decision-making capacity at the time of execution or, if incapable, this Directive is executed by a valid surrogate under Nevada law; and
c. The Directive conforms to Nevada statutory and regulatory requirements.
5. COVENANTS & RESTRICTIONS
5.1 Patient Covenants. The Patient shall:
a. Keep a copy of this Directive readily available and inform family members, caregivers, and medical facilities of its existence;
b. Obtain and wear State-approved DNR Identification if desired for prehospital recognition; and
c. Promptly notify the Attending Physician and destroy any DNR Identification upon revocation.
5.2 Physician Covenants. The Physician shall:
a. Place a copy of this Directive and any revocation notice in the Patient’s permanent medical record;
b. Enter the DNR order consistent with facility policy; and
c. Inform EMS dispatch or facility staff of the DNR status when transferring the Patient.
6. DEFAULT & REMEDIES
6.1 Events of Default. For purposes of this Directive, an “Event of Default” occurs if any Health-Care Provider or EMS Personnel, with actual knowledge of this Directive, administers Resuscitative Measures contrary to Section 3.1, absent a good-faith belief in revocation or uncertainty about validity.
6.2 Remedies.
a. Declaratory or injunctive relief may be sought to enforce the Patient’s rights under this Directive.
b. No monetary damages are created by this Directive beyond those available under existing law.
[// GUIDANCE: Nevada does not provide a private cause of action specific to DNR orders; however, equitable relief may be available. Consider additional contractual remedies only after confirming no conflict with public policy.]
7. RISK ALLOCATION
7.1 Provider Protection & Indemnification. The Patient (and the Patient’s heirs, executors, and assigns) releases and agrees to indemnify, defend, and hold harmless any Health-Care Provider or EMS Personnel who, in Good Faith, honors this Directive, against any liability, loss, claim, or expense (including reasonable attorneys’ fees) arising from acts or omissions consistent with Section 3.1.
7.2 Limitation of Liability. No Health-Care Provider or EMS Personnel acting in Good Faith and in accordance with this Directive shall be liable for civil damages or subject to criminal prosecution solely for withholding Resuscitative Measures, consistent with Nevada’s good-faith standard.
8. DISPUTE RESOLUTION
8.1 Governing Law. This Directive and any dispute arising under it shall be governed exclusively by the laws of the State of Nevada.
8.2 Forum Selection; Arbitration; Jury Waiver. Not applicable. Nothing in this Directive shall be construed as a waiver of constitutional rights to judicial review.
8.3 Injunctive Relief. The Patient and all parties acknowledge that breach of this Directive may cause irreparable harm and agree that injunctive relief is an appropriate remedy to enforce the Patient’s health-care decisions.
9. GENERAL PROVISIONS
9.1 Entire Agreement. This Directive constitutes the entire directive of the Patient regarding Resuscitative Measures and supersedes all prior inconsistent statements, whether oral or written.
9.2 Severability. If any provision is held invalid or unenforceable, the remaining provisions shall remain in full force and effect to the maximum extent permitted by law.
9.3 Amendments & Waivers. Any amendment or waiver must be in writing, signed with the same formalities as this Directive. No oral waiver shall be effective.
9.4 Successors & Assigns. This Directive is binding on the Patient’s heirs, executors, administrators, personal representatives, and all Health-Care Providers and EMS Personnel who are presented with it.
9.5 Counterparts & Electronic Signatures. This Directive may be executed in multiple counterparts, each of which shall be deemed an original. Facsimile, scanned, or secure electronic signatures are valid and binding under Nevada’s Uniform Electronic Transactions Act.
10. EXECUTION BLOCK
10.1 Patient/Declarant Signature
I, [PATIENT FULL LEGAL NAME], having read and understood this Directive, or having had it read and explained to me, hereby execute it of my own free will.
______ ___
Patient/Declarant Signature Date
10.2 Attending Physician Signature
I, the undersigned Physician, attest that I have reviewed this Directive with the Patient (or Patient’s legally authorized representative) and believe the Patient understands its implications.
______ ___
Physician Signature & License No. Date
10.3 Witness Attestation (Two adult witnesses OR a notary. Witnesses must NOT be: (i) the Patient’s health-care provider; (ii) the Patient’s spouse or relative by blood or marriage; (iii) entitled to any portion of the Patient’s estate; or (iv) financially responsible for the Patient’s medical care.)
Witness #1:
______ ___
Signature of Witness 1 Date
[PRINT NAME & ADDRESS]
Witness #2:
______ ___
Signature of Witness 2 Date
[PRINT NAME & ADDRESS]
[// GUIDANCE: If a notary is used instead of witnesses, replace Section 10.3 with an appropriate Nevada notarial acknowledgment.]
OPTIONAL: DNR IDENTIFICATION REQUEST
[ ] Check if the Patient requests issuance of Nevada-approved DNR Identification.
If checked, the Attending Physician shall complete and submit any required State forms to the Nevada Division of Public and Behavioral Health.
OPTIONAL: AGENT/LEGAL REPRESENTATIVE ACKNOWLEDGMENT
If the Patient lacks decision-making capacity and this Directive is executed by an authorized agent, guardian, or surrogate, complete below:
______ ___
Agent/Representative Signature Date
[PRINT NAME, AUTHORITY, & CONTACT INFO]