Nevada Medical Power of Attorney
This Medical Power of Attorney is governed by the laws of the State of Nevada. It allows you to appoint someone to make medical decisions on your behalf if you are unable to do so.
Principal Information:
- Name: ____________________________
- Address: ____________________________
- City, State, Zip: ____________________________
- Date of Birth: ____________________________
Agent Information:
- Name: ____________________________
- Address: ____________________________
- City, State, Zip: ____________________________
- Phone Number: ____________________________
Alternate Agent Information:
- Name: ____________________________
- Address: ____________________________
- City, State, Zip: ____________________________
- Phone Number: ____________________________
Effective Date: This Medical Power of Attorney is effective immediately upon signing, unless stated otherwise here: ____________________________.
Durability: This Medical Power of Attorney shall remain in effect until revoked or until my death.
Agent's Authority: My agent shall have the authority to make decisions regarding my medical treatment, including but not limited to:
- Consent to or refuse medical treatment.
- Access my medical records.
- Make decisions about life-sustaining treatment.
Signature:
____________________________ (Principal Signature)
Date: ____________________________
Witnesses:
This document must be signed in the presence of two witnesses or a notary public. Witnesses cannot be related to you or entitled to any part of your estate.
Witness 1: ____________________________
Date: ____________________________
Witness 2: ____________________________
Date: ____________________________
Notary Public:
State of Nevada
County of ____________________________
Subscribed and sworn to before me this ____ day of __________, 20__.
____________________________ (Notary Signature)
My Commission Expires: ____________________________