Nevada Do Not Resuscitate Order Template
This Do Not Resuscitate (DNR) Order is created in accordance with Nevada state laws regarding advance directives and end-of-life care. This document allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency.
Patient Information:
- Full Name: ______________________________
- Date of Birth: ___________________________
- Address: _________________________________
- City, State, Zip Code: ____________________
Healthcare Provider Information:
- Provider's Name: _________________________
- Provider's Contact Number: _______________
Statement of Wishes:
I, the undersigned, hereby declare that I do not wish to receive cardiopulmonary resuscitation (CPR) or any other life-sustaining treatment in the event of cardiac arrest or respiratory failure.
This decision has been made after careful consideration of my medical condition and my personal values. I understand the implications of this decision and wish to ensure that my healthcare providers respect my wishes.
Signature:
__________________________________________
Date: ____________________________________
Witness Information:
Two witnesses are required to validate this DNR Order. Witnesses cannot be related to the patient or entitled to any part of the patient’s estate.
- Witness 1 Name: __________________________
- Witness 1 Signature: ______________________
- Date: ____________________________________
- Witness 2 Name: __________________________
- Witness 2 Signature: ______________________
- Date: ____________________________________
This DNR Order is effective immediately upon signing and remains in effect until revoked or modified in writing.