[Rev. 6/2/2018 5:24:23 PM--2017]

CHAPTER 449A - CARE AND RIGHTS OF PATIENTS

GENERAL PROVISIONS

NRS 449A.001        Definitions.

NRS 449A.003        “Agency to provide nursing in the home” defined.

NRS 449A.005        “Agency to provide personal care services in the home” defined.

NRS 449A.007        “Board” defined.

NRS 449A.009        “Community-based living arrangement services” defined.

NRS 449A.011        “Community health worker” defined.

NRS 449A.013        “Community health worker pool” defined.

NRS 449A.015        “Community triage center” defined.

NRS 449A.017        “Division” defined.

NRS 449A.019        “Facility for hospice care” defined.

NRS 449A.021        “Facility for intermediate care” defined.

NRS 449A.023        “Facility for modified medical detoxification” defined.

NRS 449A.025        “Facility for refractive surgery” defined.

NRS 449A.027        “Facility for skilled nursing” defined.

NRS 449A.029        “Facility for the care of adults during the day” defined.

NRS 449A.031        “Facility for the dependent” defined.

NRS 449A.033        “Facility for the treatment of abuse of alcohol or drugs” defined.

NRS 449A.035        “Facility for the treatment of irreversible renal disease” defined.

NRS 449A.037        “Facility for transitional living for released offenders” defined.

NRS 449A.039        “Halfway house for recovering alcohol and drug abusers” defined.

NRS 449A.041        “Home for individual residential care” defined.

NRS 449A.043        “Hospice care” defined.

NRS 449A.045        “Hospital” defined.

NRS 449A.047        “Independent center for emergency medical care” defined.

NRS 449A.050        “Medical facility” defined.

NRS 449A.052        “Mobile unit” defined.

NRS 449A.054        “Nursing pool” defined.

NRS 449A.056        “Obstetric center” defined.

NRS 449A.058        “Palliative services” defined.

NRS 449A.060        “Peer support recovery organization” defined.

NRS 449A.062        “Peer support services” defined.

NRS 449A.064        “Provider of health care” defined.

NRS 449A.066        “Provider of supported living arrangement services” defined.

NRS 449A.068        “Psychiatric hospital” defined.

NRS 449A.071        “Registered nurse” defined.

NRS 449A.073        “Residential facility for groups” defined.

NRS 449A.075        “Rural clinic” defined.

NRS 449A.077        “Supported living arrangement services” defined.

NRS 449A.079        “Surgical center for ambulatory patients” defined.

NRS 449A.081        “Terminally ill” defined.

PATIENTS’ RIGHTS

NRS 449A.100        Facility to provide necessary services or arrange for transfer of patient; explanation of need for transfer and alternatives available.

NRS 449A.103        Facility to forward medical records upon certain transfers of patient.

NRS 449A.106        Specific rights: Information concerning facility; treatment; billing; visitation.

NRS 449A.109        Specific rights: Designation of persons authorized to visit patient in facility.

NRS 449A.112        Specific rights: Care; refusal of treatment and experimentation; privacy; notice of appointments and need for care; confidentiality of information concerning patient.

NRS 449A.115        Owner and administrator of certain facility prohibited from receiving certain money or property from resident or former resident; exception.

NRS 449A.118        Patient to be informed of rights upon admission to facility; required disclosures and notices.

NRS 449A.121        Procedure to insert implant in breast of patient: Informed consent required; withdrawal of consent; penalty.

NRS 449A.124        Procedure to insert implant in breast of patient: Contents of explanation form and consent form; fee for forms.

COLLECTION OF AMOUNT OWED FOR HOSPITAL CARE

NRS 449A.150        Definitions.

NRS 449A.153        “Hospital care” defined.

NRS 449A.156        “Responsible party” defined.

NRS 449A.159        Limitations on efforts of hospitals to collect; date for accrual of interest; rate of interest; limitations on additional fees.

NRS 449A.162        Limitations on efforts of hospital to collect when hospital has contractual agreement with third party that provides health coverage for care provided; return to patient of any excess amount collected; exception.

NRS 449A.165        Manner of collection.

USE OF AVERSIVE INTERVENTION OR FORMS OF RESTRAINT ON PATIENTS WITH DISABILITIES

NRS 449A.200        Definitions.

NRS 449A.203        “Aversive intervention” defined.

NRS 449A.206        “Chemical restraint” defined.

NRS 449A.209        “Corporal punishment” defined.

NRS 449A.212        “Electric shock” defined.

NRS 449A.215        “Emergency” defined.

NRS 449A.218        “Facility” defined.

NRS 449A.221        “Mechanical restraint” defined.

NRS 449A.224        “Person with a disability” defined.

NRS 449A.227        “Physical restraint” defined.

NRS 449A.230        “Verbal and mental abuse” defined.

NRS 449A.233        Aversive intervention: Prohibition on use.

NRS 449A.236        Forms of restraint: Restrictions on use.

NRS 449A.239        Physical restraint: Permissible use; report of use in emergency.

NRS 449A.242        Mechanical restraint: Permissible use; report of use in emergency.

NRS 449A.245        Chemical restraint: Permissible use; report of use.

NRS 449A.248        Authorized use of certain forms of restraint by certain facilities.

NRS 449A.251        Education and training of members of staff of facility.

NRS 449A.254        Violations: Criminal penalties; ineligibility for employment; disciplinary action.

NRS 449A.257        Violations: Report required; development and review of and compliance with corrective plan.

NRS 449A.260        Prohibition on retaliation against person for reporting or providing information regarding violation.

NRS 449A.263        Entry of denial of rights in patient’s record; notice and report of denial; action by Division.

DESIGNATION OF CAREGIVERS

NRS 449A.300        Definitions.

NRS 449A.303        “Aftercare” defined.

NRS 449A.306        “Caregiver” defined.

NRS 449A.309        “Representative of the patient” defined.

NRS 449A.312        Designation of caregiver for a patient, removal of designation and designation of new caregiver under certain circumstances; designation does not establish obligation to patient.

NRS 449A.315        Hospital to provide opportunity to designate caregiver for patient before discharge or when patient regains competence.

NRS 449A.318        Hospital to record designation or change of caregiver and request consent to release medical information to caregiver if required; hospital to record declination to designate caregiver.

NRS 449A.321        Hospital to attempt to notify caregiver before planned discharge or transfer of patient.

NRS 449A.324        Hospital to attempt to provide caregiver with discharge plan; contents of discharge plan; hospital to attempt to consult with caregiver regarding aftercare.

NRS 449A.327        Hospital to document certain actions and instructions in medical record of patient; hospital to proceed with planned discharge or transfer of patient if unable to reach caregiver.

NRS 449A.330        Hospital and employees and contractors of hospital not liable for aftercare provided improperly or not provided by caregiver.

WITHHOLDING OR WITHDRAWAL OF LIFE-SUSTAINING TREATMENT

NRS 449A.400        Short title; uniformity of application and construction.

NRS 449A.403        Definitions.

NRS 449A.406        “Advanced practice registered nurse” defined.

NRS 449A.409        “Attending advanced practice registered nurse” defined.

NRS 449A.412        “Attending physician” defined.

NRS 449A.415        “Declaration” defined.

NRS 449A.418        “Life-sustaining treatment” defined.

NRS 449A.421        “Person” defined.

NRS 449A.424        “Provider of health care” defined.

NRS 449A.427        “Qualified patient” defined.

NRS 449A.430        “Terminal condition” defined.

NRS 449A.433        Declaration relating to use of life-sustaining treatment.

NRS 449A.436        Form of declaration directing physician or advanced practice registered nurse to withhold or withdraw life-sustaining treatment.

NRS 449A.439        Form of declaration designating another person to decide to withhold or withdraw life-sustaining treatment.

NRS 449A.442        Time declaration becomes operative; duty of providers of health care.

NRS 449A.445        Revocation of declaration; entry of revocation in medical records of declarant.

NRS 449A.448        Recording determination of terminal condition and declaration.

NRS 449A.451        Treatment of qualified patients; withholding or withdrawal of artificial nutrition and hydration; treatment of pregnant patient.

NRS 449A.454        Written consent to withhold or withdraw life-sustaining treatment.

NRS 449A.457        Transfer of care of declarant.

NRS 449A.460        Immunity from civil and criminal liability and discipline for unprofessional conduct.

NRS 449A.463        Consideration of declaration and other factors; failure to follow directions of patient.

NRS 449A.466        Assumption of validity of declaration; presumption of intent to use, withhold or withdraw life-sustaining treatment not created.

NRS 449A.469        Death does not constitute suicide or homicide; effect of declaration on policy of insurance; prohibiting or requiring execution of declaration prohibited as condition for insurance or receipt of health care.

NRS 449A.472        Penalties.

NRS 449A.475        Actions contrary to reasonable medical standards not required; mercy-killing, assisted suicide or euthanasia not authorized.

NRS 449A.478        Other right or responsibility regarding use of life-sustaining treatment or withholding or withdrawal of medical care not limited.

NRS 449A.481        Validity of declaration executed in another state; effect of previously executed instrument.

PROVIDER ORDERS FOR LIFE-SUSTAINING TREATMENT

NRS 449A.500        Definitions.

NRS 449A.503        “Advanced practice registered nurse” defined.

NRS 449A.506        “Attending advanced practice registered nurse” defined.

NRS 449A.509        “Attending physician” defined.

NRS 449A.512        “Attending physician assistant” defined.

NRS 449A.515        “Do-not-resuscitate identification” defined.

NRS 449A.518        “Do-not-resuscitate order” defined.

NRS 449A.521        “Emergency care” defined.

NRS 449A.524        “Health care facility” defined.

NRS 449A.527        “Life-resuscitating treatment” defined.

NRS 449A.530        “Life-sustaining treatment” defined.

NRS 449A.533        “Other types of advance directives” defined.

NRS 449A.536        “Physician assistant” defined.

NRS 449A.539        “Provider of health care” defined.

NRS 449A.542        “Provider Order for Life-Sustaining Treatment form” or “POLST form” defined.

NRS 449A.545        “Representative of the patient” defined.

NRS 449A.548        Board to prescribe standardized POLST form; requirements.

NRS 449A.551        Explanation of POLST form to patient; completion of form; validity of form; actions authorized for patient who regains capacity.

NRS 449A.554        Revocation of POLST form; entry of revocation in medical records of patient.

NRS 449A.557        Conflict with other advance directive or do-not-resuscitate identification.

NRS 449A.560        Immunity from civil and criminal liability and from discipline for unprofessional conduct.

NRS 449A.563        Provider of health care required to comply with valid POLST form; modification by provider; transfer of care of patient; exceptions.

NRS 449A.566        Assumption of validity of POLST form; presumption of intent of patient not created if patient has revoked or not executed POLST form.

NRS 449A.569        Death does not constitute suicide or homicide; effect of POLST form on policy of insurance; prohibiting or requiring execution of POLST form prohibited as condition for insurance or receipt of health care.

NRS 449A.572        Unlawful acts; penalty.

NRS 449A.575        Actions contrary to reasonable medical standards not required; mercy-killing, euthanasia or assisted suicide not authorized; rights associated with other advance directives not impaired; right to make decisions concerning emergency care or life-sustaining treatment not affected.

NRS 449A.578        Validity of POLST form executed in another state.

NRS 449A.581        Regulations.

ADVANCE DIRECTIVES FOR PSYCHIATRIC CARE

NRS 449A.600        Definitions.

NRS 449A.603        “Advance directive for psychiatric care” or “advance directive” defined.

NRS 449A.606        “Attending physician” defined.

NRS 449A.609        “Principal” defined.

NRS 449A.612        “Provider of health care” defined.

NRS 449A.615        “Psychiatric care” defined.

NRS 449A.618        Execution of advance directive; period of effectiveness.

NRS 449A.621        Form.

NRS 449A.624        Requirements for advance directive to become operative; effect.

NRS 449A.627        No presumption concerning intention of person without advance directive.

NRS 449A.630        Provider to make advance directive part of principal’s medical record.

NRS 449A.633        Revocation.

NRS 449A.636        Provider to comply with advance directive; exceptions.

NRS 449A.639        Transfer of care of principal.

NRS 449A.642        Provider to inquire whether person has advance directive for psychiatric care; immunity from liability for certain actions relating to advance directive.

NRS 449A.645        Validity of advance directive executed in another state or instrument executed before May 26, 2017.

REGISTRY OF ADVANCE DIRECTIVES FOR HEALTH CARE

NRS 449A.700        Definitions.

NRS 449A.703        “Advance directive” defined.

NRS 449A.706        “Registrant” defined.

NRS 449A.709        “Registry” defined.

NRS 449A.712        Establishment and maintenance; information to be included in Registry.

NRS 449A.715        Registration of advance directive: Requirements; duties of Secretary of State.

NRS 449A.718        Access to advance directive.

NRS 449A.721        Removal of advance directive of deceased registrant.

NRS 449A.724        Secretary of State not required to determine accuracy of contents of advance directive or validity of advance directive; effect of registration, failure to register and failure to notify Secretary of State of revocation of advance directive.

NRS 449A.727        Provider of health care not required to inquire whether patient has registered advance directive or access Registry; immunity of provider of health care from criminal and civil liability.

NRS 449A.730        Immunity of Secretary of State and deputies, employees and attorneys of Secretary of State.

NRS 449A.733        Suspension of components of Registry and duties of Secretary of State if sufficient money not available; fees authorized; acceptance of gifts and grants.

NRS 449A.736        Deposit, accounting and use of money received; interest and income earned on money received; payment of claims.

NRS 449A.739        Regulations.

_________

GENERAL PROVISIONS

      NRS 449A.001  Definitions.  As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 449A.003 to 449A.081, inclusive, have the meanings ascribed to them in those sections.

      (Added to NRS by 1973, 1278; A 1975, 366, 897; 1977, 641; 1979, 160, 1113; 1983, 1657; 1985, 1736; 1989, 304, 1034, 1037; 1993, 2556; 1995, 1600; 1999, 248, 970; 2001, 1341, 2518; 2005, 485, 532, 1379, 1517, 2165, 2350; 2011, 1337; 2013, 3055; 2015, 2160, 2172; 2017, 1409, 1570) — (Substituted in revision for part of NRS 449.001)

      NRS 449A.003  “Agency to provide nursing in the home” defined.

      1.  “Agency to provide nursing in the home” means any person or governmental organization which provides in the home, through its employees or by contractual arrangement with other persons, skilled nursing and assistance and training in health and housekeeping skills.

      2.  The term does not include:

      (a) A provider of community-based living arrangement services during any period in which the provider of community-based living arrangement services is engaged in providing community-based living arrangement services; or

      (b) A provider of supported living arrangement services during any period in which the provider of supported living arrangement services is engaged in providing supported living arrangement services.

      (Added to NRS by 1979, 160; A 1985, 1737; 2005, 1379; 2017, 1409) — (Substituted in revision for part of NRS 449.0015)

      NRS 449A.005  “Agency to provide personal care services in the home” defined.

      1.  “Agency to provide personal care services in the home” means any person, other than a natural person, which provides in the home the services authorized pursuant to NRS 449.1935 to elderly persons or persons with disabilities.

      2.  The term does not include:

      (a) An independent contractor who provides nonmedical services specified in NRS 449.1935 without the assistance of employees;

      (b) An organized group of persons composed of the family or friends of a person needing personal care services that employs or contracts with persons to provide nonmedical services specified in NRS 449.1935 for the person if:

             (1) The organization of the group of persons is set forth in a written document that is made available for review by the Division upon request; and

             (2) The personal care services are provided to only one person or one family who resides in the same residence;

      (c) An intermediary service organization; or

      (d) A person or agency that contracts with the Aging and Disability Services Division of the Department of Health and Human Services to provide temporary respite services.

      3.  As used in this section:

      (a) “Intermediary service organization” has the meaning ascribed to it in NRS 449.4304.

      (b) “Temporary respite services” means services provided through a contract with the Aging and Disability Services Division of the Department of Health and Human Services to a natural person on a periodic basis to provide a respite for a regular provider of services.

      (Added to NRS by 2005, 2164; A 2007, 1225; 2009, 2399; 2013, 134; 2017, 1410) — (Substituted in revision for part of NRS 449.0021)

      NRS 449A.007  “Board” defined.  “Board” means the State Board of Health.

      (Added to NRS by 1985, 1735) — (Substituted in revision for part of NRS 449.0025)

      NRS 449A.009  “Community-based living arrangement services” defined.  “Community-based living arrangement services” has the meaning ascribed to it in NRS 433.605.

      (Added to NRS by 2017, 1409) — (Substituted in revision for part of NRS 449.0026)

      NRS 449A.011  “Community health worker” defined.  “Community health worker” means a natural person who:

      1.  Lives in or otherwise has a connection to the community in which he or she provides services.

      2.  Is trained by a provider of health care to provide certain services which do not require the community health worker to be licensed.

      3.  Provides services at the direction of a facility for the dependent, medical facility or provider of health care which may include, without limitation, outreach and the coordination of health care.

      (Added to NRS by 2015, 2172) — (Substituted in revision for part of NRS 449.0027)

      NRS 449A.013  “Community health worker pool” defined.  “Community health worker pool” means a person or agency which provides, for compensation and through its employees or by contract with community health workers, the services of community health workers to any natural person, medical facility or facility for the dependent. The term does not include an independent contractor who personally provides the services of a community health worker or a facility for the dependent or any medical facility other than a community health worker pool which provides the services of a community health worker.

      (Added to NRS by 2015, 2172) — (Substituted in revision for part of NRS 449.0028)

      NRS 449A.015  “Community triage center” defined.  “Community triage center” means a facility that provides on a 24-hour basis medical assessments of and short-term monitoring services for persons with mental illness and abusers of alcohol or drugs in a manner which does not require that the assessments and services be provided in a licensed hospital.

      (Added to NRS by 2005, 532) — (Substituted in revision for part of NRS 449.0031)

      NRS 449A.017  “Division” defined.  “Division” means the Division of Public and Behavioral Health of the Department of Health and Human Services.

      (Added to NRS by 2013, 3055) — (Substituted in revision for part of NRS 449.0032)

      NRS 449A.019  “Facility for hospice care” defined.  “Facility for hospice care” means a facility which is operated to provide hospice care.

      (Added to NRS by 1999, 248) — (Substituted in revision for part of NRS 449.0033)

      NRS 449A.021  “Facility for intermediate care” defined.  “Facility for intermediate care” means an establishment operated and maintained to provide 24-hour personal and medical supervision, for a person who does not have illness, disease, injury or other condition that would require the degree of care and treatment which a hospital or facility for skilled nursing is designed to provide.

      (Added to NRS by 1973, 1279; A 1985, 1737; 1991, 1974) — (Substituted in revision for part of NRS 449.0038)

      NRS 449A.023  “Facility for modified medical detoxification” defined.  “Facility for modified medical detoxification” means a facility that provides 24-hour medical monitoring of treatment and detoxification in a manner which does not require that the service be provided in a licensed hospital.

      (Added to NRS by 1999, 969) — (Substituted in revision for part of NRS 449.00385)

      NRS 449A.025  “Facility for refractive surgery” defined.

      1.  “Facility for refractive surgery” means a freestanding facility that provides limited medical services relating to surgical treatments for patients with refractive errors of the eye, including the preoperative care and evaluation of those patients, the surgical treatment of those patients and the postoperative care and evaluation of those patients.

      2.  As used in this section:

      (a) “Postoperative care” has the meaning ascribed to it in NRS 449.24892.

      (b) “Preoperative care” has the meaning ascribed to it in NRS 449.24893.

      (Added to NRS by 2001, 1339; A 2005, 2693; 2009, 452) — (Substituted in revision for part of NRS 449.00387)

      NRS 449A.027  “Facility for skilled nursing” defined.

      1.  “Facility for skilled nursing” means an establishment which provides continuous skilled nursing and related care as prescribed by a physician to a patient in the facility who is not in an acute episode of illness and whose primary need is the availability of such care on a continuous basis.

      2.  “Facility for skilled nursing” does not include a facility which meets the requirements of a general or any other special hospital.

      (Added to NRS by 1973, 1279; A 1985, 1738) — (Substituted in revision for part of NRS 449.0039)

      NRS 449A.029  “Facility for the care of adults during the day” defined.  “Facility for the care of adults during the day” means an establishment operated and maintained to provide care during the day on a temporary or permanent basis for aged or infirm persons. The term does not include a halfway house for recovering alcohol and drug abusers.

      (Added to NRS by 1983, 1657; A 1985, 1736; 2001, 2518) — (Substituted in revision for part of NRS 449.004)

      NRS 449A.031  “Facility for the dependent” defined.  “Facility for the dependent” includes:

      1.  A facility for the treatment of abuse of alcohol or drugs;

      2.  A halfway house for recovering alcohol and drug abusers;

      3.  A facility for the care of adults during the day;

      4.  A residential facility for groups;

      5.  An agency to provide personal care services in the home;

      6.  A facility for transitional living for released offenders;

      7.  A home for individual residential care;

      8.  A peer support recovery organization; and

      9.  A community health worker pool.

      (Added to NRS by 1985, 1735; A 2001, 2518; 2005, 2165, 2350; 2011, 356; 2015, 2160, 2172) — (Substituted in revision for part of NRS 449.0045)

      NRS 449A.033  “Facility for the treatment of abuse of alcohol or drugs” defined.  “Facility for the treatment of abuse of alcohol or drugs” means any public or private establishment which provides residential treatment, including mental and physical restoration, of abusers of alcohol or drugs. It does not include a medical facility or services offered by volunteers or voluntary organizations.

      (Added to NRS by 1975, 366; A 1985, 1736; 1993, 1624; 1999, 1871; 2001, 417; 2005, 22nd Special Session, 56; 2013, 3055; 2015, 305, 2475) — (Substituted in revision for part of NRS 449.00455)

      NRS 449A.035  “Facility for the treatment of irreversible renal disease” defined.  “Facility for the treatment of irreversible renal disease” means a facility that is not part of a hospital and which provides peritoneal dialysis or hemodialysis or trains a person with a permanent irreversible renal impairment to perform dialysis for himself or herself.

      (Added to NRS by 1985, 1735) — (Substituted in revision for part of NRS 449.0046)

      NRS 449A.037  “Facility for transitional living for released offenders” defined.

      1.  “Facility for transitional living for released offenders” means a residence that provides housing and a living environment for persons who have been released from prison and who require assistance with reintegration into the community, other than such a residence that is operated or maintained by a state or local government or an agency thereof. The term does not include a halfway house for recovering alcohol and drug abusers or a facility for the treatment of abuse of alcohol or drugs.

      2.  As used in this section, “person who has been released from prison” means:

      (a) A parolee.

      (b) A person who is participating in:

             (1) A judicial program pursuant to NRS 209.4886 or 213.625; or

             (2) A correctional program pursuant to NRS 209.4888 or 213.632.

      (c) A person who is supervised by the Division of Parole and Probation of the Department of Public Safety through residential confinement pursuant to NRS 213.371 to 213.410, inclusive.

      (d) A person who has been released from prison by expiration of his or her term of sentence.

      (Added to NRS by 2005, 2349) — (Substituted in revision for part of NRS 449.0055)

      NRS 449A.039  “Halfway house for recovering alcohol and drug abusers” defined.  “Halfway house for recovering alcohol and drug abusers” means a residence that provides housing and a living environment for recovering alcohol and drug abusers and is operated to facilitate their reintegration into the community, but does not provide any treatment for alcohol or drug abuse. The term does not include a facility for transitional living for released offenders.

      (Added to NRS by 2001, 2518; A 2005, 2350) — (Substituted in revision for part of NRS 449.008)

      NRS 449A.041  “Home for individual residential care” defined.  “Home for individual residential care” means a home in which a natural person furnishes food, shelter, assistance and limited supervision, for compensation, to not more than two persons with intellectual disabilities or with physical disabilities or who are aged or infirm, unless the persons receiving those services are related within the third degree of consanguinity or affinity to the person providing those services. The term does not include:

      1.  A halfway house for recovering alcohol and drug abusers; or

      2.  A home in which community-based living arrangement services or supported living arrangement services are provided by a provider of such services during any period in which the provider is engaged in providing the services.

      (Added to NRS by 1993, 2556; A 2001, 2518; 2005, 1380; 2013, 696; 2017, 1410) — (Substituted in revision for part of NRS 449.0105)

      NRS 449A.043  “Hospice care” defined.

      1.  “Hospice care” means a centrally administered program of palliative services and supportive services provided by an interdisciplinary team directed by a physician. The program includes the provision of physical, psychological, custodial and spiritual care for persons who are terminally ill and their families. The care may be provided in the home, at a residential facility or at a medical facility at any time of the day or night. The term includes the supportive care and services provided to the family after the patient dies.

      2.  As used in this section:

      (a) “Family” includes the immediate family, the person who primarily cared for the patient and other persons with significant personal ties to the patient, whether or not related by blood.

      (b) “Interdisciplinary team” means a group of persons who work collectively to meet the special needs of terminally ill patients and their families and includes such persons as a physician, registered nurse, social worker, member of the clergy and trained volunteer.

      (Added to NRS by 1979, 1112; A 1985, 1737; 1989, 1035; 2005, 485) — (Substituted in revision for part of NRS 449.0115)

      NRS 449A.045  “Hospital” defined.  “Hospital” means an establishment for the diagnosis, care and treatment of human illness, including care available 24 hours each day from persons licensed to practice professional nursing who are under the direction of a physician, services of a medical laboratory and medical, radiological, dietary and pharmaceutical services.

      (Added to NRS by 1973, 1279; A 1985, 1737) — (Substituted in revision for part of NRS 449.012)

      NRS 449A.047  “Independent center for emergency medical care” defined.  “Independent center for emergency medical care” means a facility, structurally separate and distinct from a hospital, which provides limited services for the treatment of a medical emergency.

      (Added to NRS by 1985, 1735) — (Substituted in revision for part of NRS 449.013)

      NRS 449A.050  “Medical facility” defined.  “Medical facility” includes:

      1.  A surgical center for ambulatory patients;

      2.  An obstetric center;

      3.  An independent center for emergency medical care;

      4.  An agency to provide nursing in the home;

      5.  A facility for intermediate care;

      6.  A facility for skilled nursing;

      7.  A facility for hospice care;

      8.  A hospital;

      9.  A psychiatric hospital;

      10.  A facility for the treatment of irreversible renal disease;

      11.  A rural clinic;

      12.  A nursing pool;

      13.  A facility for modified medical detoxification;

      14.  A facility for refractive surgery;

      15.  A mobile unit; and

      16.  A community triage center.

      (Added to NRS by 1973, 1279; A 1975, 366; 1979, 161, 887, 1113; 1983, 1657; 1985, 1736; 1989, 304, 1035, 1037; 1999, 248, 970; 2001, 1341; 2005, 532, 2693) — (Substituted in revision for part of NRS 449.0151)

      NRS 449A.052  “Mobile unit” defined.

      1.  Except as otherwise provided in subsection 2, “mobile unit” means a motor vehicle that is specially designed, constructed and equipped to provide any of the medical services provided by a medical facility described in subsections 1 to 13, inclusive, of NRS 449A.050.

      2.  “Mobile unit” does not include:

      (a) A motor vehicle that is operated by a medical facility described in subsections 1 to 13, inclusive, of NRS 449A.050 which is accredited by the Joint Commission on Accreditation of Healthcare Organizations or the American Osteopathic Association;

      (b) A motor vehicle that is operated by a health center that is funded under section 330 of the Public Health Service Act, 42 U.S.C. § 254b, as amended; or

      (c) A vehicle operated under the authority of a permit issued pursuant to chapter 450B of NRS.

      (Added to NRS by 2001, 1339; A 2003, 421) — (Substituted in revision for part of NRS 449.01515)

      NRS 449A.054  “Nursing pool” defined.

      1.  “Nursing pool” means a person or agency which provides for compensation, through its employees or by contractual arrangement with other persons, nursing services to any natural person, medical facility or facility for the dependent.

      2.  The term does not include:

      (a) An independent contractor who provides such services without the assistance of employees;

      (b) A nursing pool based in a medical facility or facility for the dependent;

      (c) A provider of community-based living arrangement services during any period in which the provider of community-based living arrangement services is engaged in providing community-based living arrangement services; or

      (d) A provider of supported living arrangement services during any period in which the provider of supported living arrangement services is engaged in providing supported living arrangement services.

      (Added to NRS by 1989, 303; A 2005, 1380; 2017, 1410) — (Substituted in revision for part of NRS 449.0153)

      NRS 449A.056  “Obstetric center” defined.  “Obstetric center” means a facility that is not part of a hospital and provides services for normal, uncomplicated births.

      (Added to NRS by 1985, 1735) — (Substituted in revision for part of NRS 449.0155)

      NRS 449A.058  “Palliative services” defined.  “Palliative services” means services and treatments directed toward the control of pain and symptoms which provide the greatest degree of relief for the longest period while minimizing any adverse effects of the services and treatments, including, without limitation, any side effects of any medications given or administered.

      (Added to NRS by 2005, 485) — (Substituted in revision for part of NRS 449.0156)

      NRS 449A.060  “Peer support recovery organization” defined.  “Peer support recovery organization” means a person or agency which, for compensation, provides peer support services to persons who are 18 years of age or older and who suffer from mental illness or addiction or identify themselves as at risk for mental illness or addiction.

      (Added to NRS by 2015, 2159) — (Substituted in revision for part of NRS 449.01563)

      NRS 449A.062  “Peer support services” defined.  “Peer support services” means supportive services relating to mental health, addiction or substance abuse which:

      1.  Do not require the person offering the supportive services to be licensed.

      2.  Are offered to a person in need of such services.

      3.  May include, without limitation:

      (a) Helping to stabilize such a person;

      (b) Helping such a person with recovery;

      (c) Helping such a person to access community-based behavioral health care;

      (d) Assisting such a person during a crisis situation or an intervention;

      (e) Providing assistance with preventive care;

      (f) Providing strategies and education relating to the whole health needs of such a person; and

      (g) Providing encouragement, peer mentoring and training in self-advocacy and self-direction to such a person.

      (Added to NRS by 2015, 2159) — (Substituted in revision for part of NRS 449.01566)

      NRS 449A.064  “Provider of health care” defined.  “Provider of health care” has the meaning ascribed to it in NRS 629.031.

      (Added to NRS by 1995, 1600) — (Substituted in revision for part of NRS 449.0157)

      NRS 449A.066  “Provider of supported living arrangement services” defined.  “Provider of supported living arrangement services” means a natural person who or a partnership, firm, corporation, association, state or local government or agency thereof that has been issued a certificate pursuant to NRS 435.3305 to 435.339, inclusive, and the regulations adopted pursuant to NRS 435.3305 to 435.339, inclusive.

      (Added to NRS by 2005, 1379) — (Substituted in revision for part of NRS 449.0159)

      NRS 449A.068  “Psychiatric hospital” defined.  “Psychiatric hospital” means a hospital for the diagnosis, care and treatment of mental illness which provides 24-hour care.

      (Added to NRS by 1985, 1735; A 2017, 1895) — (Substituted in revision for part of NRS 449.0165)

      NRS 449A.071  “Registered nurse” defined.  “Registered nurse” has the meaning ascribed to it in NRS 632.019.

      (Added to NRS by 2005, 1517) — (Substituted in revision for part of NRS 449.0167)

      NRS 449A.073  “Residential facility for groups” defined.

      1.  Except as otherwise provided in subsection 2, “residential facility for groups” means an establishment that furnishes food, shelter, assistance and limited supervision to a person with an intellectual disability or with a physical disability or a person who is aged or infirm. The term includes, without limitation, an assisted living facility.

      2.  The term does not include:

      (a) An establishment which provides care only during the day;

      (b) A natural person who provides care for no more than two persons in his or her own home;

      (c) A natural person who provides care for one or more persons related to him or her within the third degree of consanguinity or affinity;

      (d) A halfway house for recovering alcohol and drug abusers; or

      (e) A home in which community-based living arrangement services or supported living arrangement services are provided by a provider of such services during any period in which the provider is providing the services.

      (Added to NRS by 1973, 1278; A 1979, 212; 1983, 1657; 1985, 930, 1736; 1991, 1974; 1993, 1213; 1999, 114, 125; 2001, 57, 546, 2519, 2522; 2013, 696; 2017, 1411) — (Substituted in revision for part of NRS 449.017)

      NRS 449A.075  “Rural clinic” defined.  “Rural clinic” means a facility located in an area that is not designated as an urban area by the Bureau of the Census, where medical services are provided by a physician assistant licensed pursuant to chapter 630 or 633 of NRS or an advanced practice registered nurse licensed pursuant to NRS 632.237 who is under the supervision of a licensed physician.

      (Added to NRS by 1985, 1735; A 2001, 782; 2007, 1862; 2013, 2082) — (Substituted in revision for part of NRS 449.0175)

      NRS 449A.077  “Supported living arrangement services” defined.  “Supported living arrangement services” has the meaning ascribed to it in NRS 435.3315.

      (Added to NRS by 2005, 1379) — (Substituted in revision for part of NRS 449.0185)

      NRS 449A.079  “Surgical center for ambulatory patients” defined.  “Surgical center for ambulatory patients” means a facility with limited medical services available for diagnosis or treatment of patients by surgery where the patients’ recovery, in the opinion of the surgeon, will not require care as a patient in the facility for more than 24 hours.

      (Added to NRS by 1975, 366; A 1985, 1736; 1993, 207) — (Substituted in revision for part of NRS 449.019)

      NRS 449A.081  “Terminally ill” defined.  “Terminally ill” means a medical diagnosis made by a physician that a person has an anticipated life expectancy of not more than 12 months.

      (Added to NRS by 2005, 485) — (Substituted in revision for part of NRS 449.0195)

PATIENTS’ RIGHTS

      NRS 449A.100  Facility to provide necessary services or arrange for transfer of patient; explanation of need for transfer and alternatives available.

      1.  Every medical facility and facility for the dependent must provide the services necessary to treat properly a patient in a particular case or must be able to arrange the transfer of the patient to another facility which can provide that care.

      2.  A patient may be transferred to another facility only if the patient has received an explanation of the need to transfer the patient and the alternatives available, unless the condition of the patient necessitates an immediate transfer to a facility for a higher level of care and the patient is unable to understand the explanation.

      (Added to NRS by 1983, 820; A 1985, 1747; 1999, 1051; 2011, 360) — (Substituted in revision for NRS 449.700)

      NRS 449A.103  Facility to forward medical records upon certain transfers of patient.

      1.  If a patient in a medical facility or facility for the dependent is transferred to another medical facility or facility for the dependent, a division facility or a physician licensed to practice medicine, the facility shall forward a copy of the medical records of the patient, on or before the date the patient is transferred, to the other medical facility or facility for the dependent, the division facility or the physician. The facility is not required to obtain the oral or written consent of the patient to forward a copy of the medical records.

      2.  As used in this section:

      (a) “Division facility” means any unit or subunit operated by a division of the Department of Health and Human Services pursuant to title 39 of NRS.

      (b) “Medical records” includes a medical history of the patient, a summary of the current physical condition of the patient and a discharge summary which contains the information necessary for the proper treatment of the patient.

      (Added to NRS by 1991, 2349; A 1993, 2725; 1999, 1051; 2011, 360) — (Substituted in revision for NRS 449.705)

      NRS 449A.106  Specific rights: Information concerning facility; treatment; billing; visitation.  Every patient of a medical facility or facility for the dependent has the right to:

      1.  Receive information concerning any other medical or educational facility or facility for the dependent associated with the facility at which he or she is a patient which relates to the care of the patient.

      2.  Obtain information concerning the professional qualifications or associations of the persons who are treating the patient.

      3.  Receive the name of the person responsible for coordinating the care of the patient in the facility.

      4.  Be advised if the facility in which he or she is a patient proposes to perform experiments on patients which affect the patient’s own care or treatment.

      5.  Receive from his or her physician a complete and current description of the patient’s diagnosis, plan for treatment and prognosis in terms which the patient is able to understand. If it is not medically advisable to give this information to the patient, the physician shall:

      (a) Provide the information to an appropriate person responsible for the patient; and

      (b) Inform that person that he or she shall not disclose the information to the patient.

      6.  Receive from his or her physician the information necessary for the patient to give his or her informed consent to a procedure or treatment. Except in an emergency, this information must not be limited to a specific procedure or treatment and must include:

      (a) A description of the significant medical risks involved;

      (b) Any information on alternatives to the treatment or procedure if the patient requests that information;

      (c) The name of the person responsible for the procedure or treatment; and

      (d) The costs likely to be incurred for the treatment or procedure and any alternative treatment or procedure.

      7.  Examine the bill for his or her care and receive an explanation of the bill, whether or not the patient is personally responsible for payment of the bill.

      8.  Know the regulations of the facility concerning his or her conduct at the facility.

      9.  Receive, within reasonable restrictions as to time and place, visitors of the patient’s choosing, including, without limitation, friends and members of the patient’s family.

      (Added to NRS by 1983, 820; A 1985, 906, 1748; 1999, 1052; 2001, 3047; 2011, 360) — (Substituted in revision for NRS 449.710)

      NRS 449A.109  Specific rights: Designation of persons authorized to visit patient in facility.

      1.  If, as a result of the incapacitation of a patient or the inability of a patient to communicate, the patient of a medical facility or facility for the dependent who is 18 years of age or older is unable to inform the staff of the facility of the persons whom the patient authorizes to visit the patient at the facility, the facility shall allow visitation rights to any person designated by the patient in a letter, form or other document authorizing visitation executed in accordance with subsection 2. The visitation rights required by this subsection must be:

      (a) Provided in accordance with the visitation policies of the facility; and

      (b) The same visitation rights that are provided to a member of the patient’s family who is legally related to the patient.

      2.  A person 18 years of age or older wishing to designate a person for the purposes of establishing visitation rights in a medical facility or facility for the dependent may execute a letter, form or other document authorizing visitation in substantially the following form:

 

      (Date)..................................

       I, ..............................., (patient who is designating another person as having visitation rights of the patient) do hereby designate .................................. (person who is being designated as having visitation rights of the patient) as having the right to visit me in a medical facility or facility for the dependent. I hereby instruct all staff of a medical facility or facility for the dependent in which I am a patient to admit ...................................... (person who is being designated as having visitation rights of the patient) to my room and afford him or her the same visitation rights as are provided to members of my family who are legally related to me during my time as a patient.

........................................................

       (Signed)

 

      (Added to NRS by 2003, 1879; A 2011, 361) — (Substituted in revision for NRS 449.715)

      NRS 449A.112  Specific rights: Care; refusal of treatment and experimentation; privacy; notice of appointments and need for care; confidentiality of information concerning patient.

      1.  Every patient of a medical facility or facility for the dependent has the right to:

      (a) Receive considerate and respectful care.

      (b) Refuse treatment to the extent permitted by law and to be informed of the consequences of that refusal.

      (c) Refuse to participate in any medical experiments conducted at the facility.

      (d) Retain his or her privacy concerning the patient’s program of medical care.

      (e) Have any reasonable request for services reasonably satisfied by the facility considering its ability to do so.

      (f) Receive continuous care from the facility. The patient must be informed:

             (1) Of the patient’s appointments for treatment and the names of the persons available at the facility for those treatments; and

             (2) By his or her physician or an authorized representative of the physician, of the patient’s need for continuing care.

      2.  Except as otherwise provided in NRS 108.640, 239.0115, 439.538, 442.300 to 442.330, inclusive, and 449A.103 and chapter 629 of NRS, discussions of the care of a patient, consultation with other persons concerning the patient, examinations or treatments, and all communications and records concerning the patient are confidential. The patient must consent to the presence of any person who is not directly involved with the patient’s care during any examination, consultation or treatment.

      (Added to NRS by 1983, 821; A 1985, 1748; 1989, 2057; 1991, 2350; 1999, 1052, 3512; 2007, 1979, 2110; 2011, 362) — (Substituted in revision for NRS 449.720)

      NRS 449A.115  Owner and administrator of certain facility prohibited from receiving certain money or property from resident or former resident; exception.

      1.  Except as otherwise provided in subsection 3 and notwithstanding any other provision of law, an owner or administrator of a medical facility or facility for the dependent is not entitled to receive, and must not receive:

      (a) Any money, personal property or real property that is devised or bequeathed by will to the owner or administrator by a resident or former resident of the facility.

      (b) Any proceeds from a life insurance policy upon the life or body of a resident or former resident of the facility.

      2.  Except as otherwise provided in subsection 3, any money, property, proceeds or interest therein that is described in subsection 1 passes in accordance with law as if the owner or administrator of the medical facility or facility for the dependent had predeceased the decedent resident or former resident.

      3.  The provisions of subsections 1 and 2 do not apply if the owner or administrator of the medical facility or facility for the dependent is the spouse, legal guardian or next of kin of the resident or former resident of the facility or home, as applicable.

      (Added to NRS by 2011, 696) — (Substituted in revision for NRS 449.725)

      NRS 449A.118  Patient to be informed of rights upon admission to facility; required disclosures and notices.

      1.  Every medical facility and facility for the dependent shall inform each patient or the patient’s legal representative, upon the admission of the patient to the facility, of the patient’s rights as listed in NRS 449A.100 and 449A.106 to 449A.115, inclusive.

      2.  In addition to the requirements of subsection 1, if a person with a disability is a patient at a facility, as that term is defined in NRS 449A.218, the facility shall inform the patient of his or her rights pursuant to NRS 449A.200 to 449A.263, inclusive.

      3.  In addition to the requirements of subsections 1 and 2, every hospital shall, upon the admission of a patient to the hospital, provide to the patient or the patient’s legal representative a written disclosure approved by the Director of the Department of Health and Human Services, which written disclosure must set forth:

      (a) Notice of the existence of the Bureau for Hospital Patients created pursuant to NRS 232.462;

      (b) The address and telephone number of the Bureau; and

      (c) An explanation of the services provided by the Bureau, including, without limitation, the services for dispute resolution described in subsection 3 of NRS 232.462.

      4.  In addition to the requirements of subsections 1, 2 and 3, every hospital shall, upon the discharge of a patient from the hospital, provide to the patient or the patient’s legal representative a written disclosure approved by the Director, which written disclosure must set forth:

      (a) If the hospital is a major hospital:

             (1) Notice of the reduction or discount available pursuant to NRS 439B.260, including, without limitation, notice of the criteria a patient must satisfy to qualify for a reduction or discount under that section; and

             (2) Notice of any policies and procedures the hospital may have adopted to reduce charges for services provided to persons or to provide discounted services to persons, which policies and procedures are in addition to any reduction or discount required to be provided pursuant to NRS 439B.260. The notice required by this subparagraph must describe the criteria a patient must satisfy to qualify for the additional reduction or discount, including, without limitation, any relevant limitations on income and any relevant requirements as to the period within which the patient must arrange to make payment.

      (b) If the hospital is not a major hospital, notice of any policies and procedures the hospital may have adopted to reduce charges for services provided to persons or to provide discounted services to persons. The notice required by this paragraph must describe the criteria a patient must satisfy to qualify for the reduction or discount, including, without limitation, any relevant limitations on income and any relevant requirements as to the period within which the patient must arrange to make payment.

Ê As used in this subsection, “major hospital” has the meaning ascribed to it in NRS 439B.115.

      5.  In addition to the requirements of subsections 1 to 4, inclusive, every hospital shall post in a conspicuous place in each public waiting room in the hospital a legible sign or notice in 14-point type or larger, which sign or notice must:

      (a) Provide a brief description of any policies and procedures the hospital may have adopted to reduce charges for services provided to persons or to provide discounted services to persons, including, without limitation:

             (1) Instructions for receiving additional information regarding such policies and procedures; and

             (2) Instructions for arranging to make payment;

      (b) Be written in language that is easy to understand; and

      (c) Be written in English and Spanish.

      (Added to NRS by 1983, 822; A 1985, 1749; 1999, 1053, 3252; 2003, 1880; 2005, 947; 2011, 362, 697) — (Substituted in revision for NRS 449.730)

      NRS 449A.121  Procedure to insert implant in breast of patient: Informed consent required; withdrawal of consent; penalty.

      1.  A physician shall not perform any procedure to insert an implant in the breast of a patient unless within 5 days before the procedure is performed the physician has:

      (a) Discussed with the patient and any other person whose consent is required pursuant to paragraph (b), the advantages, disadvantages and risks associated with the procedure; and

      (b) Obtained informed consent in writing from the following persons freely and without coercion:

             (1) The patient if he or she is 18 years of age or over or legally emancipated and competent to give that consent, and from the patient’s legal guardian, if any;

             (2) The parent or guardian of a patient under 18 years of age and not legally emancipated; or

             (3) The legal guardian of a patient of any age who has been adjudicated mentally incapacitated,

Ê and the required consent was not withdrawn pursuant to subsection 3 before the procedure began.

      2.  An informed consent requires that the person whose consent is sought be adequately informed as to:

      (a) The nature and consequences of the procedure;

      (b) The reasonable risks, possible side effects, benefits and purposes of the procedure; and

      (c) Any alternative procedures available.

      3.  The consent of a patient or other person whose consent is required pursuant to paragraph (b) of subsection 1 may be withdrawn in writing at any time before the procedure has begun, with or without cause.

      4.  A physician satisfies the requirements of:

      (a) Paragraph (a) of subsection 1 if the physician provides the patient and any other person whose consent is required pursuant to paragraph (b) of subsection 1 with a copy of the current explanation form prepared by the Division pursuant to NRS 449A.124 in a language that the person is able to read.

      (b) Paragraph (b) of subsection 1 if the person or persons whose consent is required sign a copy of the current consent form prepared by the Division pursuant to NRS 449A.124 freely and without coercion and the consent is not withdrawn pursuant to subsection 3 before the procedure has begun. The consent form must be in a language that the person who signs the form is able to read.

      5.  Any person who violates the provisions of this section is guilty of a misdemeanor.

      (Added to NRS by 1991, 1690) — (Substituted in revision for NRS 449.740)

      NRS 449A.124  Procedure to insert implant in breast of patient: Contents of explanation form and consent form; fee for forms.

      1.  The Division shall prepare and provide to physicians upon request:

      (a) An explanation form for a procedure to insert an implant in the breast of a person which includes:

             (1) An explanation of the advantages, disadvantages and risks associated with a procedure to insert an implant in the breast of a person, including any known side effects; and

             (2) Any other information the Division determines to be useful to a person contemplating a procedure to insert an implant in the breast; and

      (b) A consent form for a procedure to insert an implant in the breast of a person which includes:

             (1) The nature and consequences of the procedure;

             (2) The reasonable risks, possible side effects, benefits and purposes of the procedure; and

             (3) Any alternative procedures available.

      2.  The Division shall revise the explanation form and consent form as necessary to keep the medical information current.

      3.  The Division shall charge and collect a fee for all forms distributed pursuant to this section that is adequate to cover the cost of producing the forms.

      (Added to NRS by 1991, 1690) — (Substituted in revision for NRS 449.750)

COLLECTION OF AMOUNT OWED FOR HOSPITAL CARE

      NRS449A.150  Definitions.  As used in NRS 449A.150 to 449A.165, inclusive, unless the context otherwise requires, the words and terms defined in NRS 449A.153 and 449A.156 have the meanings ascribed to them in those sections.

      (Added to NRS by 2007, 1497; A 2011, 1524) — (Substituted in revision for NRS 449.751)

      NRS449A.153  “Hospital care” defined.  “Hospital care” has the meaning ascribed to it in NRS 428.155.

      (Added to NRS by 2007, 1497) — (Substituted in revision for NRS 449.753)

      NRS449A.156  “Responsible party” defined.  “Responsible party” means the person who received the hospital care, the parent or guardian of the person who received the hospital care or another natural person who is legally responsible or has agreed to be responsible for the payment to the hospital of any charges incurred in connection with the hospital care.

      (Added to NRS by 2007, 1497) — (Substituted in revision for NRS 449.755)

      NRS449A.159  Limitations on efforts of hospitals to collect; date for accrual of interest; rate of interest; limitations on additional fees.

      1.  When a person receives hospital care, the hospital must not proceed with any efforts to collect on any amount owed to the hospital for the hospital care from the responsible party, other than for any copayment or deductible, if the responsible party has health insurance or may be eligible for Medicaid, the Children’s Health Insurance Program or any other public program which may pay all or part of the bill, until the hospital has submitted a bill to the health insurance company or public program and the health insurance company or public program has made a determination concerning payment of the claim.

      2.  Collection efforts may begin and interest may begin to accrue on any amount owed to the hospital for hospital care which remains unpaid by the responsible party not sooner than 30 days after the responsible party is sent a bill by mail stating the amount that he or she is responsible to pay which has been established after receiving a determination concerning payment of the claim by any insurer or public program and after applying any discounts. Interest must accrue at a rate which does not exceed the prime rate at the largest bank in Nevada as ascertained by the Commissioner of Financial Institutions on January 1 or July 1, as the case may be, immediately preceding the date on which the payment becomes due, plus 2 percent. The rate must be adjusted accordingly on each January 1 and July 1 thereafter until the payment is satisfied.

      3.  Except for the interest authorized pursuant to subsection 2 and any court costs and attorney’s fees awarded by a court, no other fees may be charged concerning the amount that remains unpaid, including, without limitation, collection fees, other attorney’s fees or any other fees or costs.

      (Added to NRS by 2007, 1497; A 2011, 1525) — (Substituted in revision for NRS 449.757)

      NRS 449A.162  Limitations on efforts of hospital to collect when hospital has contractual agreement with third party that provides health coverage for care provided; return to patient of any excess amount collected; exception.

      1.  Except as otherwise provided in subsection 3, if a hospital provides hospital care to a person who has a policy of health insurance issued by a third party that provides health coverage for care provided at that hospital and the hospital has a contractual agreement with the third party, the hospital:

      (a) Shall proceed with any efforts to collect on any amount owed to the hospital for the hospital care in accordance with the provisions of NRS 449A.159.

      (b) Shall not collect or attempt to collect from the patient or other responsible party more than the sum of the amounts of any deductible, copayment or coinsurance payable by or on behalf of the patient under the policy of health insurance.

      (c) Shall not collect or attempt to collect that amount from:

             (1) Any proceeds or potential proceeds of a civil action brought by or on behalf of the patient, including, without limitation, any amount awarded for medical expenses; or

             (2) An insurer other than an insurer that provides coverage under a policy of health insurance or an insurer that provides coverage for medical payments under a policy of casualty insurance.

      2.  If the hospital collects or receives any payments from an insurer that provides coverage for medical payments under a policy of casualty insurance, the hospital shall, not later than 30 days after a determination is made concerning coverage, return to the patient any amount collected or received that is in excess of the deductible, copayment or coinsurance payable by or on behalf of the patient under the policy of health insurance.

      3.  This section does not apply to:

      (a) Amounts owed to the hospital which are not covered under the policy of health insurance; or

      (b) Medicaid, Medicare, the Children’s Health Insurance Program or any other public program which may pay all or part of the bill.

      4.  This section does not limit any rights of a patient to contest an attempt to collect an amount owed to a hospital, including, without limitation, contesting a lien obtained by a hospital.

      5.  As used in this section, “third party” means:

      (a) An insurer, as defined in NRS 679B.540;

      (b) A health benefit plan, as defined in NRS 689A.540, for employees which provides coverage for services and care at a hospital;

      (c) A participating public agency, as defined in NRS 287.04052, and any other local governmental agency of the State of Nevada which provides a system of health insurance for the benefit of its officers and employees, and the dependents of officers and employees, pursuant to chapter 287 of NRS; or

      (d) Any other insurer or organization providing health coverage or benefits in accordance with state or federal law.

      (Added to NRS by 2011, 1524; A 2017, 4115) — (Substituted in revision for NRS 449.758)

      NRS449A.165  Manner of collection.  A hospital, or any person acting on its behalf who seeks to collect a debt from a responsible party for any amount owed to the hospital for hospital care must collect the debt in a professional, fair and lawful manner. When collecting such a debt, the hospital or other person acting on its behalf must act in accordance with sections 803 to 812, inclusive, of the federal Fair Debt Collection Practices Act, as amended, 15 U.S.C. §§ 1692a to 1692j, inclusive, even if the hospital or person acting on its behalf is not otherwise subject to the provisions of that Act.

      (Added to NRS by 2007, 1498) — (Substituted in revision for NRS 449.759)

USE OF AVERSIVE INTERVENTION OR FORMS OF RESTRAINT ON PATIENTS WITH DISABILITIES

      NRS 449A.200  Definitions.  As used in NRS 449A.200 to 449A.263, inclusive, unless the context otherwise requires, the words and terms defined in NRS 449A.203 to 449A.230, inclusive, have the meanings ascribed to them in those sections.

      (Added to NRS by 1999, 3247) — (Substituted in revision for NRS 449.765)

      NRS 449A.203  “Aversive intervention” defined.  “Aversive intervention” means any of the following actions if the action is used to punish a person with a disability or to eliminate, reduce or discourage maladaptive behavior of a person with a disability:

      1.  The use of noxious odors and tastes;

      2.  The use of water and other mists or sprays;

      3.  The use of blasts of air;

      4.  The use of corporal punishment;

      5.  The use of verbal and mental abuse;

      6.  The use of electric shock;

      7.  Requiring a person to perform exercise under forced conditions if the:

      (a) Person is required to perform the exercise because the person exhibited a behavior that is related to his or her disability;

      (b) Exercise is harmful to the health of the person because of his or her disability; or

      (c) Nature of the person’s disability prevents the person from engaging in the exercise;

      8.  Any intervention, technique or procedure that deprives a person of the use of one or more of the person’s senses, regardless of the length of the deprivation, including, without limitation, the use of sensory screens; or

      9.  The deprivation of necessities needed to sustain the health of a person, regardless of the length of the deprivation, including, without limitation, the denial or unreasonable delay in the provision of:

      (a) Food or liquid at a time when it is customarily served; or

      (b) Medication.

Ê The term does not include the withholding or withdrawal of life-sustaining treatment in accordance with NRS 449A.454 or 449A.500 to 449A.581, inclusive.

      (Added to NRS by 1999, 3247; A 2013, 2288) — (Substituted in revision for NRS 449.766)

      NRS 449A.206  “Chemical restraint” defined.  “Chemical restraint” means the administration of drugs for the specific and exclusive purpose of controlling an acute or episodic aggressive behavior when alternative intervention techniques have failed to limit or control the behavior. The term does not include the administration of drugs on a regular basis, as prescribed by a physician, to treat the symptoms of mental, physical, emotional or behavioral disorders and for assisting a person in gaining self-control over his or her impulses.

      (Added to NRS by 1999, 3247) — (Substituted in revision for NRS 449.767)

      NRS 449A.209  “Corporal punishment” defined.  “Corporal punishment” means the intentional infliction of physical pain, including, without limitation, hitting, pinching or striking.

      (Added to NRS by 1999, 3248) — (Substituted in revision for NRS 449.768)

      NRS 449A.212  “Electric shock” defined.  “Electric shock” means the application of electric current to a person’s skin or body. The term does not include electroconvulsive therapy.

      (Added to NRS by 1999, 3248) — (Substituted in revision for NRS 449.769)

      NRS 449A.215  “Emergency” defined.  “Emergency” means a situation in which immediate intervention is necessary to protect the physical safety of a person or others from an immediate threat of physical injury or to protect against an immediate threat of severe property damage.

      (Added to NRS by 1999, 3248) — (Substituted in revision for NRS 449.770)

      NRS 449A.218  “Facility” defined.  “Facility” means a facility licensed pursuant to chapter 449 of NRS that is a psychiatric hospital or a unit of a hospital that is specifically designated to provide care and services to persons with psychiatric or developmental disabilities.

      (Added to NRS by 1999, 3248) — (Substituted in revision for NRS 449.771)

      NRS 449A.221  “Mechanical restraint” defined.  “Mechanical restraint” means the use of devices, including, without limitation, mittens, straps and restraint chairs to limit a person’s movement or hold a person immobile.

      (Added to NRS by 1999, 3248) — (Substituted in revision for NRS 449.772)

      NRS 449A.224  “Person with a disability” defined.  “Person with a disability” means a person who:

      1.  Has a physical or mental impairment that substantially limits one or more of the major life activities of the person;

      2.  Has a record of such an impairment; or

      3.  Is regarded as having such an impairment.

      (Added to NRS by 1999, 3248) — (Substituted in revision for NRS 449.773)

      NRS 449A.227  “Physical restraint” defined.  “Physical restraint” means the use of physical contact to limit a person’s movement or hold a person immobile.

      (Added to NRS by 1999, 3248) — (Substituted in revision for NRS 449.774)

      NRS 449A.230  “Verbal and mental abuse” defined.  “Verbal and mental abuse” means actions or utterances that are intended to cause and actually cause severe emotional distress to a person.

      (Added to NRS by 1999, 3248) — (Substituted in revision for NRS 449.775)

      NRS 449A.233  Aversive intervention: Prohibition on use.  A person employed by a facility licensed pursuant to chapter 449 of NRS or any other person shall not use any aversive intervention on a person with a disability who is a patient at the facility.

      (Added to NRS by 1999, 3248) — (Substituted in revision for NRS 449.776)

      NRS 449A.236  Forms of restraint: Restrictions on use.  A person employed by a facility licensed pursuant to chapter 449 of NRS or any other person shall not:

      1.  Except as otherwise provided in NRS 449A.239, use physical restraint on a person with a disability who is a patient at the facility.

      2.  Except as otherwise provided in NRS 449A.242, use mechanical restraint on a person with a disability who is a patient at the facility.

      3.  Except as otherwise provided in NRS 449A.245, use chemical restraint on a person with a disability who is a patient at the facility.

      (Added to NRS by 1999, 3248) — (Substituted in revision for NRS 449.777)

      NRS 449A.239  Physical restraint: Permissible use; report of use in emergency.

      1.  Except as otherwise provided in subsection 2, physical restraint may be used on a person with a disability who is a patient at a facility only if:

      (a) An emergency exists that necessitates the use of physical restraint;

      (b) The physical restraint is used only for the period that is necessary to contain the behavior of the patient so that the patient is no longer an immediate threat of causing physical injury to himself or herself or others or causing severe property damage; and

      (c) The use of force in the application of physical restraint does not exceed the force that is reasonable and necessary under the circumstances precipitating the use of physical restraint.

      2.  Physical restraint may be used on a person with a disability who is a patient at a facility and the provisions of subsection 1 do not apply if the physical restraint is used to:

      (a) Assist the patient in completing a task or response if the patient does not resist the application of physical restraint or if the patient’s resistance is minimal in intensity and duration;

      (b) Escort or carry a patient to safety if the patient is in danger in his or her present location; or

      (c) Conduct medical examinations or treatments on the patient that are necessary.

      3.  If physical restraint is used on a person with a disability who is a patient at a facility in an emergency, the use of the procedure must be reported as a denial of rights pursuant to NRS 449A.263, regardless of whether the use of the procedure is authorized by statute. The report must be made not later than 1 working day after the procedure is used.

      (Added to NRS by 1999, 3249) — (Substituted in revision for NRS 449.778)

      NRS 449A.242  Mechanical restraint: Permissible use; report of use in emergency.

      1.  Except as otherwise provided in subsection 2, mechanical restraint may be used on a person with a disability who is a patient at a facility only if:

      (a) An emergency exists that necessitates the use of mechanical restraint;

      (b) A medical order authorizing the use of mechanical restraint is obtained from the patient’s treating physician or advanced practice registered nurse before the application of the mechanical restraint or not later than 15 minutes after the application of the mechanical restraint;

      (c) The physician or advanced practice registered nurse who signed the order required pursuant to paragraph (b) or the attending physician or attending advanced practice registered nurse examines the patient not later than 1 working day immediately after the application of the mechanical restraint;

      (d) The mechanical restraint is applied by a member of the staff of the facility who is trained and qualified to apply mechanical restraint;

      (e) The patient is given the opportunity to move and exercise the parts of his or her body that are restrained at least 10 minutes per every 60 minutes of restraint;

      (f) A member of the staff of the facility lessens or discontinues the restraint every 15 minutes to determine whether the patient will stop or control his or her inappropriate behavior without the use of the restraint;

      (g) The record of the patient contains a notation that includes the time of day that the restraint was lessened or discontinued pursuant to paragraph (f), the response of the patient and the response of the member of the staff of the facility who applied the mechanical restraint;

      (h) A member of the staff of the facility continuously monitors the patient during the time that mechanical restraint is used on the patient; and

      (i) The patient is released from the mechanical restraint as soon as the behavior of the patient no longer presents an immediate threat to himself or herself or others.

      2.  Mechanical restraint may be used on a person with a disability who is a patient at a facility and the provisions of subsection 1 do not apply if the mechanical restraint is used to:

      (a) Treat the medical needs of a patient;

      (b) Protect a patient who is known to be at risk of injury to himself or herself because the patient lacks coordination or suffers from frequent loss of consciousness;

      (c) Provide proper body alignment to a patient; or

      (d) Position a patient who has physical disabilities in a manner prescribed in the patient’s plan of treatment.

      3.  If mechanical restraint is used on a person with a disability who is a patient at a facility in an emergency, the use of the procedure must be reported as a denial of rights pursuant to NRS 449A.263, regardless of whether the use of the procedure is authorized by statute. The report must be made not later than 1 working day after the procedure is used.

      (Added to NRS by 1999, 3249; A 2017, 1766) — (Substituted in revision for NRS 449.779)

      NRS 449A.245  Chemical restraint: Permissible use; report of use.

      1.  Chemical restraint may only be used on a person with a disability who is a patient at a facility if:

      (a) The patient has been diagnosed as a person with mental illness, as defined in NRS 433A.115, and is receiving mental health services from a facility;

      (b) The chemical restraint is administered to the patient while he or she is under the care of the facility;

      (c) An emergency exists that necessitates the use of chemical restraint;

      (d) A medical order authorizing the use of chemical restraint is obtained from the patient’s attending physician, psychiatrist or advanced practice registered nurse;

      (e) The physician, psychiatrist or advanced practice registered nurse who signed the order required pursuant to paragraph (d) examines the patient not later than 1 working day immediately after the administration of the chemical restraint; and

      (f) The chemical restraint is administered by a person licensed to administer medication.

      2.  If chemical restraint is used on a person with a disability who is a patient, the use of the procedure must be reported as a denial of rights pursuant to NRS 449A.263, regardless of whether the use of the procedure is authorized by statute. The report must be made not later than 1 working day after the procedure is used.

      (Added to NRS by 1999, 3250; A 2017, 1767) — (Substituted in revision for NRS 449.780)

      NRS 449A.248  Authorized use of certain forms of restraint by certain facilities.  Notwithstanding the provisions of NRS 449A.236 to 449A.245, inclusive, to the contrary, a facility may use or authorize the use of physical restraint, mechanical restraint or chemical restraint on a person with a disability who is a patient if the facility is:

      1.  Accredited by a nationally recognized accreditation association or agency; or

      2.  Certified for participation in the Medicaid or Medicare program,

Ê only to the extent that the accreditation or certification allows the use of such restraint.

      (Added to NRS by 1999, 3248) — (Substituted in revision for NRS 449.781)

      NRS 449A.251  Education and training of members of staff of facility.

      1.  Each facility shall develop a program of education for the members of the staff of the facility to provide instruction in positive behavioral interventions and positive behavioral supports that:

      (a) Includes positive methods to modify the environment of patients to promote adaptive behavior and reduce the occurrence of inappropriate behavior;

      (b) Includes methods to teach skills to patients so that patients can replace inappropriate behavior with adaptive behavior;

      (c) Includes methods to enhance a patient’s independence and quality of life;

      (d) Includes the use of the least intrusive methods to respond to and reinforce the behavior of patients; and

      (e) Offers a process for designing interventions based upon the patient that are focused on promoting appropriate changes in behavior as well as enhancing the overall quality of life for the patient.

      2.  Each facility shall provide appropriate training for the members of the staff of the facility who are authorized to carry out and monitor physical restraint and mechanical restraint to ensure that those members of the staff are competent and qualified to carry out the procedures in accordance with NRS 449A.200 to 449A.263, inclusive.

      (Added to NRS by 1999, 3250) — (Substituted in revision for NRS 449.782)

      NRS 449A.254  Violations: Criminal penalties; ineligibility for employment; disciplinary action.

      1.  Unless a more severe penalty is prescribed by specific statute, a person who willfully uses aversive intervention on a person with a disability who is a patient at a facility or, except as otherwise provided in NRS 449A.248, violates NRS 449A.236:

      (a) For a first violation that does not result in substantial bodily harm to the person with a disability, is guilty of a gross misdemeanor.

      (b) For a first violation that results in substantial bodily harm to the person with a disability, is guilty of a category B felony.

      (c) For a second or subsequent violation, is guilty of a category B felony.

Ê A person who is convicted of a category B felony pursuant to this section shall be punished by imprisonment in the state prison for a minimum term of not less than 1 year and a maximum term of not more than 6 years, or by a fine of not more than $5,000, or by both fine and imprisonment.

      2.  A person who is convicted pursuant to this section is ineligible for 5 years for employment with a facility.

      3.  A conviction pursuant to this section is, when applicable, grounds for disciplinary action against the person so convicted and the facility where the violation occurred. The Division may recommend to the appropriate agency or board the suspension or revocation of the professional license, registration, certificate or permit of a person convicted.

      (Added to NRS by 1999, 3251) — (Substituted in revision for NRS 449.783)

      NRS 449A.257  Violations: Report required; development and review of and compliance with corrective plan.

      1.  A facility where a violation of the provisions of NRS 449A.200 to 449A.263, inclusive, occurs shall report the violation to the Division not later than 24 hours after the violation occurred, or as soon thereafter as the violation is discovered.

      2.  A facility where a violation occurred shall develop, in cooperation with the Division, a corrective plan to ensure that within 30 calendar days after the violation occurred, appropriate action is taken by the facility to prevent future violations.

      3.  The Division shall forward the plan to the Board. The Board shall review the plan to ensure that it complies with applicable federal law and the statutes and regulations of this state. The Board may require appropriate revision of the plan to ensure compliance.

      4.  If the facility where the violation occurred does not meet the requirements of the plan to the satisfaction of the Board, the Board may direct the agency that administers funding for the facility to withhold state funding for the facility until the facility meets the requirements of the plan.

      (Added to NRS by 1999, 3251) — (Substituted in revision for NRS 449.784)

      NRS 449A.260  Prohibition on retaliation against person for reporting or providing information regarding violation.  An officer, administrator or employee of a facility licensed pursuant to this chapter shall not retaliate against any person for having:

      1.  Reported a violation of NRS 449A.200 to 449A.263, inclusive; or

      2.  Provided information regarding a violation of NRS 449A.200 to 449A.263, inclusive,

Ê by a facility or a member of the staff of the facility.

      (Added to NRS by 1999, 3252) — (Substituted in revision for NRS 449.785)

      NRS 449A.263  Entry of denial of rights in patient’s record; notice and report of denial; action by Division.

      1.  A denial of rights of a person with a disability who is a patient of a facility pursuant to NRS 449A.200 to 449A.263, inclusive, must be entered in the patient’s record. Notice of the denial must be provided to the administrator of the facility.

      2.  If the administrator of a facility receives notice of a denial of rights pursuant to subsection 1, the administrator shall cause a full report to be prepared which must set forth in detail the factual circumstances surrounding the denial. A copy of the report must be provided to the Division.

      3.  The Division:

      (a) Shall receive reports made pursuant to subsection 2;

      (b) May investigate apparent violations of the rights of persons with disabilities who are patients at facilities; and

      (c) May act to resolve disputes relating to apparent violations.

      (Added to NRS by 1999, 3252) — (Substituted in revision for NRS 449.786)

DESIGNATION OF CAREGIVERS

      NRS 449A.300  Definitions.  As used in NRS 449A.300 to 449A.330, inclusive, unless the context otherwise requires, the words and terms defined in NRS 449A.303, 449A.306 and 449A.309 have the meanings ascribed to them in those sections.

      (Added to NRS by 2015, 176) — (Substituted in revision for NRS 449.790)

      NRS 449A.303  “Aftercare” defined.  “Aftercare” means care or assistance that is provided to a patient after the patient is discharged following inpatient treatment at a hospital.

      (Added to NRS by 2015, 176) — (Substituted in revision for NRS 449.792)

      NRS 449A.306  “Caregiver” defined.  “Caregiver” means a person designated as such pursuant to NRS 449A.312, including, without limitation, a relative, spouse, partner, foster parent, friend or neighbor.

      (Added to NRS by 2015, 176) — (Substituted in revision for NRS 449.794)

      NRS 449A.309  “Representative of the patient” defined.  “Representative of the patient” means a legal guardian of the patient, a person designated by the patient to make decisions governing the withholding or withdrawal of life-sustaining treatment pursuant to NRS 449A.433 or a person given power of attorney to make decisions concerning health care for the patient pursuant to NRS 162A.700 to 162A.865, inclusive.

      (Added to NRS by 2015, 176) — (Substituted in revision for NRS 449.796)

      NRS 449A.312  Designation of caregiver for a patient, removal of designation and designation of new caregiver under certain circumstances; designation does not establish obligation to patient.

      1.  A caregiver may be designated for a patient by:

      (a) The patient if he or she is 18 years of age or older and of sound mind;

      (b) The representative of the patient if the patient is 18 years of age or older and incompetent; or

      (c) The parent or legal guardian of the patient if the patient is less than 18 years of age.

      2.  A patient described in subsection 1 may have a caregiver designated for him or her upon admission to a hospital as an inpatient in the manner described in NRS 449A.315.

      3.  If a caregiver is unable or unwilling to perform the duties of a caregiver, the designation of that person as a caregiver may be removed and a new caregiver may be designated by:

      (a) The patient if he or she is 18 years of age or older and of sound mind;

      (b) The representative of the patient if the patient is 18 years of age or older and incompetent; or

      (c) The parent or legal guardian of the patient if the patient is less than 18 years of age.

      4.  A caregiver is under no obligation to a patient solely because the patient, the representative of the patient or the parent or guardian of the patient has designated the caregiver pursuant to this section.

      (Added to NRS by 2015, 176) — (Substituted in revision for NRS 449.798)

      NRS 449A.315  Hospital to provide opportunity to designate caregiver for patient before discharge or when patient regains competence.

      1.  After admitting a patient as an inpatient and before discharging the patient, a hospital shall provide the opportunity to designate a caregiver for the patient to:

      (a) The patient if he or she is 18 years of age or older and of sound mind;

      (b) The representative of the patient if the patient is 18 years of age or older and incompetent; or

      (c) The parent or legal guardian of the patient if the patient is less than 18 years of age.

      2.  If a patient is unconscious or otherwise incompetent upon admission to a hospital as an inpatient and later regains competence while he or she is an inpatient at the hospital, the hospital shall, after the patient regains competence, provide the patient with the opportunity to designate a caregiver.

      (Added to NRS by 2015, 176) — (Substituted in revision for NRS 449.801)

      NRS 449A.318  Hospital to record designation or change of caregiver and request consent to release medical information to caregiver if required; hospital to record declination to designate caregiver.

      1.  If a patient, the representative of a patient or the parent or guardian of a patient designates a caregiver pursuant to NRS 449A.315 or changes a caregiver pursuant to NRS 449A.312, the hospital shall:

      (a) Record the designation or change of the caregiver, the relationship of the caregiver to the patient and the name, telephone number and address of the caregiver in the medical record of the patient; and

      (b) If required by the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, and any regulations adopted pursuant thereto or any other federal or state law, request the written consent of the patient, the representative of the patient or the parent or guardian of the patient, as applicable, to release medical information to the caregiver in a manner that complies with the applicable laws.

      2.  If a patient, the representative of a patient or the parent or guardian of a patient declines to designate a caregiver after being given the opportunity to do so pursuant to NRS 449A.315, the hospital shall record the declination in the medical record of the patient.

      (Added to NRS by 2015, 177) — (Substituted in revision for NRS 449.803)

      NRS 449A.321  Hospital to attempt to notify caregiver before planned discharge or transfer of patient.  If a patient, the representative of a patient or the parent or guardian of a patient has provided consent for the hospital to release medical information to a caregiver pursuant to subsection 1 of NRS 449A.318, the hospital shall, before the patient is discharged or transferred to another facility, attempt to notify the caregiver of the planned discharge or transfer.

      (Added to NRS by 2015, 177) — (Substituted in revision for NRS 449.805)

      NRS 449A.324  Hospital to attempt to provide caregiver with discharge plan; contents of discharge plan; hospital to attempt to consult with caregiver regarding aftercare.  If a patient, the representative of a patient or the parent or guardian of a patient has provided consent for a hospital to release medical information to a caregiver pursuant to subsection 1 of NRS 449A.318, the hospital shall, before the patient is discharged other than to a facility licensed pursuant to this chapter:

      1.  Attempt to provide the caregiver with a discharge plan. A discharge plan must include, without limitation:

      (a) The name and contact information of the caregiver;

      (b) A description of all necessary aftercare, including, without limitation, any requirements to maintain the ability of the patient to reside at home; and

      (c) Contact information for:

             (1) Any providers of health care, community resources or other providers of services necessary to carry out the discharge plan; and

             (2) An employee of the hospital who will be available before the patient is discharged to answer questions concerning the discharge plan.

      2.  Attempt to consult with the caregiver, in person or using video technology, concerning the aftercare set forth in the discharge plan. Such consultation must include, without limitation:

      (a) A demonstration of the aftercare set forth in the discharge plan, performed by an appropriate member of the hospital staff in a culturally and linguistically appropriate manner; and

      (b) An opportunity for the caregiver to ask questions concerning the aftercare.

      (Added to NRS by 2015, 177) — (Substituted in revision for NRS 449.807)

      NRS 449A.327  Hospital to document certain actions and instructions in medical record of patient; hospital to proceed with planned discharge or transfer of patient if unable to reach caregiver.

      1.  A hospital shall document in the medical record of the patient:

      (a) The attempt or completion of any actions required pursuant to NRS 449A.321 or 449A.324;

      (b) Any instructions given pursuant to NRS 449A.324; and

      (c) The date and time at which such instructions were given.

      2.  If a hospital is unable to reach a caregiver after attempting to provide any information pursuant to NRS 449A.321 or 449A.324, the hospital must proceed with the discharge or transfer of the patient as scheduled.

      (Added to NRS by 2015, 178) — (Substituted in revision for NRS 449.809)

      NRS 449A.330  Hospital and employees and contractors of hospital not liable for aftercare provided improperly or not provided by caregiver.  A hospital or an employee or contractor of a hospital that acts in compliance with NRS 449A.300 to 449A.330, inclusive, is not liable for any aftercare that is provided improperly or not provided by a caregiver.

      (Added to NRS by 2015, 178) — (Substituted in revision for NRS 449.811)

WITHHOLDING OR WITHDRAWAL OF LIFE-SUSTAINING TREATMENT

      NRS 449A.400  Short title; uniformity of application and construction.

      1.  NRS 449A.400 to 449A.481, inclusive, may be cited as the Uniform Act on Rights of the Terminally Ill.

      2.  NRS 449A.400 to 449A.481, inclusive, must be applied and construed to effectuate its general purpose to make uniform the law with respect to the subject of those sections among states enacting the Uniform Act on Rights of the Terminally Ill.

      (Added to NRS by 1991, 629; A 2017, 1757) — (Substituted in revision for NRS 449.535)

      NRS 449A.403  Definitions.  As used in NRS 449A.400 to 449A.481, inclusive, unless the context otherwise requires, the words and terms defined in NRS 449A.406 to 449A.430, inclusive, have the meanings ascribed to them in those sections.

      (Added to NRS by 1977, 759; A 1991, 632; 2017, 1757) — (Substituted in revision for NRS 449.540)

      NRS 449A.406  “Advanced practice registered nurse” defined.  “Advanced practice registered nurse” means a registered nurse who holds a valid license as an advanced practice registered nurse issued by the State Board of Nursing pursuant to NRS 632.237.

      (Added to NRS by 2017, 1757)

      NRS 449A.409  “Attending advanced practice registered nurse” defined.  “Attending advanced practice registered nurse” means an advanced practice registered nurse who has primary responsibility for the treatment and care of the patient.

      (Added to NRS by 2017, 1757)

      NRS 449A.412  “Attending physician” defined.  “Attending physician” means the physician who has primary responsibility for the treatment and care of the patient.

      (Added to NRS by 1977, 759; A 1991, 632) — (Substituted in revision for NRS 449.550)

      NRS 449A.415  “Declaration” defined.  “Declaration” means a writing executed in accordance with the requirements of NRS 449A.433.

      (Added to NRS by 1977, 759; A 1991, 632) — (Substituted in revision for NRS 449.560)

      NRS 449A.418  “Life-sustaining treatment” defined.  “Life-sustaining treatment” means a medical procedure or intervention that, when administered to a patient, serves only to prolong the process of dying.

      (Added to NRS by 1977, 759; A 1991, 633) — (Substituted in revision for NRS 449.570)

      NRS 449A.421  “Person” defined.  “Person” includes a government or a governmental subdivision or agency.

      (Added to NRS by 1991, 629) — (Substituted in revision for NRS 449.575)

      NRS 449A.424  “Provider of health care” defined.  “Provider of health care” means a person who is licensed, certified or otherwise authorized by the law of this state to administer health care in the ordinary course of business or practice of a profession.

      (Added to NRS by 1991, 629) — (Substituted in revision for NRS 449.581)

      NRS 449A.427  “Qualified patient” defined.  “Qualified patient” means a patient 18 or more years of age who has executed a declaration and who has been determined by the attending physician or attending advanced practice registered nurse to be in a terminal condition.

      (Added to NRS by 1991, 629; A 2017, 1757) — (Substituted in revision for NRS 449.585)

      NRS 449A.430  “Terminal condition” defined.  “Terminal condition” means an incurable and irreversible condition that, without the administration of life-sustaining treatment, will, in the opinion of the attending physician or attending advanced practice registered nurse, result in death within a relatively short time.

      (Added to NRS by 1977, 759; A 1991, 633; 2017, 1757) — (Substituted in revision for NRS 449.590)

      NRS 449A.433  Declaration relating to use of life-sustaining treatment.

      1.  A person of sound mind and 18 or more years of age may execute at any time a declaration governing the withholding or withdrawal of life-sustaining treatment. The declarant may designate another natural person of sound mind and 18 or more years of age to make decisions governing the withholding or withdrawal of life-sustaining treatment. The declaration must be signed by the declarant, or another at the declarant’s direction, and attested by two witnesses.

      2.  A physician or other provider of health care who is furnished a copy of the declaration shall make it a part of the declarant’s medical record and, if unwilling to comply with the declaration, promptly so advise the declarant and any person designated to act for the declarant.

      (Added to NRS by 1977, 759; A 1985, 1747; 1991, 633) — (Substituted in revision for NRS 449.600)

      NRS 449A.436  Form of declaration directing physician or advanced practice registered nurse to withhold or withdraw life-sustaining treatment.  A declaration directing a physician or advanced practice registered nurse to withhold or withdraw life-sustaining treatment may, but need not, be in the following form:

 

DECLARATION

 

If I should have an incurable and irreversible condition that, without the administration of life-sustaining treatment, will, in the opinion of my attending physician or attending advanced practice registered nurse, cause my death within a relatively short time, and I am no longer able to make decisions regarding my medical treatment, I direct my attending physician or attending advanced practice registered nurse, pursuant to NRS 449A.400 to 449A.481, inclusive, to withhold or withdraw treatment that only prolongs the process of dying and is not necessary for my comfort or to alleviate pain.

 

If you wish to include this statement in this declaration, you must INITIAL the statement in the box provided:

 

       Withholding or withdrawal of artificial nutrition and hydration may result in death by starvation or dehydration. Initial this box if you want to receive or continue receiving artificial nutrition and hydration by way of the gastrointestinal tract after all other treatment is withheld pursuant to this declaration.

 

                                                                                           [............................................ ]

 

Signed this ........................ day of ................, ......

 

                                                               Signature .........................................................

                                                               Address ...........................................................

 

The declarant voluntarily signed this writing in my presence.

 

                                                               Witness ...........................................................

                                                               Address ...........................................................

 

                                                               Witness ...........................................................

                                                               Address ...........................................................

 

      (Added to NRS by 1977, 760; A 1991, 633; 1993, 2790; 2017, 1757) — (Substituted in revision for NRS 449.610)

      NRS 449A.439  Form of declaration designating another person to decide to withhold or withdraw life-sustaining treatment.

      1.  A declaration that designates another person to make decisions governing the withholding or withdrawal of life-sustaining treatment may, but need not, be in the following form:

 

DECLARATION

 

If I should have an incurable and irreversible condition that, without the administration of life-sustaining treatment, will, in the opinion of my attending physician or attending advanced practice registered nurse, cause my death within a relatively short time, and I am no longer able to make decisions regarding my medical treatment, I appoint ............................... or, if he or she is not reasonably available or is unwilling to serve, .............................., to make decisions on my behalf regarding withholding or withdrawal of treatment that only prolongs the process of dying and is not necessary for my comfort or to alleviate pain, pursuant to NRS 449A.400 to 449A.481, inclusive. (If the person or persons I have so appointed are not reasonably available or are unwilling to serve, I direct my attending physician or attending advanced practice registered nurse, pursuant to those sections, to withhold or withdraw treatment that only prolongs the process of dying and is not necessary for my comfort or to alleviate pain.)

Strike language in parentheses if you do not desire it.

 

If you wish to include this statement in this declaration, you must INITIAL the statement in the box provided:

 

       Withholding or withdrawal of artificial nutrition and hydration may result in death by starvation or dehydration. Initial this box if you want to receive or continue receiving artificial nutrition and hydration by way of the gastrointestinal tract after all other treatment is withheld pursuant to this declaration.

                                                                                           [............................................ ]

 

Signed this ........................ day of ................, ......

 

                                                               Signature .........................................................

                                                               Address ...........................................................

 

The declarant voluntarily signed this writing in my presence.

 

                                                               Witness ...........................................................

                                                               Address ...........................................................

 

                                                               Witness ...........................................................

                                                               Address ...........................................................

 

Name and address of each designee.

 

                                                               Name ................................................................

                                                               Address ...........................................................

 

      2.  The designation of an agent pursuant to chapter 162A of NRS, or the judicial appointment of a guardian, who is authorized to make decisions regarding the withholding or withdrawal of life-sustaining treatment, constitutes for the purpose of NRS 449A.400 to 449A.481, inclusive, a declaration designating another person to act for the declarant pursuant to subsection 1.

      (Added to NRS by 1991, 630; A 1993, 2791; 2009, 209; 2017, 1758) — (Substituted in revision for NRS 449.613)

      NRS 449A.442  Time declaration becomes operative; duty of providers of health care.  A declaration becomes operative when it is communicated to the attending physician or attending advanced practice registered nurse and the declarant is determined by the attending physician or attending advanced practice registered nurse to be in a terminal condition and no longer able to make decisions regarding administration of life-sustaining treatment. When the declaration becomes operative, the attending physician and other providers of health care shall act in accordance with its provisions and with the instructions of a person designated pursuant to NRS 449A.433 or comply with the requirements of NRS 449A.457 to transfer care of the declarant.

      (Added to NRS by 1991, 631; A 2017, 1759) — (Substituted in revision for NRS 449.617)

      NRS 449A.445  Revocation of declaration; entry of revocation in medical records of declarant.

      1.  A declarant may revoke a declaration at any time and in any manner, without regard to his or her mental or physical condition. A revocation is effective upon its communication to the attending physician or other provider of health care by the declarant or a witness to the revocation.

      2.  The attending physician or other provider of health care shall make the revocation a part of the declarant’s medical record.

      (Added to NRS by 1977, 760; A 1987, 1309; 1991, 635) — (Substituted in revision for NRS 449.620)

      NRS 449A.448  Recording determination of terminal condition and declaration.  Upon determining that a declarant is in a terminal condition, the attending physician or attending advanced practice registered nurse who knows of a declaration shall record the determination, and the terms of the declaration if not already a part of the record, in the declarant’s medical record.

      (Added to NRS by 1991, 631; A 2017, 1759) — (Substituted in revision for NRS 449.622)

      NRS 449A.451  Treatment of qualified patients; withholding or withdrawal of artificial nutrition and hydration; treatment of pregnant patient.

      1.  A qualified patient may make decisions regarding life-sustaining treatment so long as the patient is able to do so.

      2.  NRS 449A.400 to 449A.481, inclusive, do not affect the responsibility of the attending physician or other provider of health care to provide treatment for a patient’s comfort or alleviation of pain.

      3.  Artificial nutrition and hydration by way of the gastrointestinal tract shall be deemed a life-sustaining treatment and must be withheld or withdrawn from a qualified patient unless a different desire is expressed in writing by the patient. For a patient who has no effective declaration, artificial nutrition and hydration must not be withheld unless a different desire is expressed in writing by the patient’s authorized representative or the family member with the authority to consent or withhold consent.

      4.  Life-sustaining treatment must not be withheld or withdrawn pursuant to a declaration from a qualified patient known to the attending physician or attending advanced practice registered nurse to be pregnant so long as it is probable that the fetus will develop to the point of live birth with continued application of life-sustaining treatment.

      (Added to NRS by 1991, 631; A 2017, 1760) — (Substituted in revision for NRS 449.624)

      NRS 449A.454  Written consent to withhold or withdraw life-sustaining treatment.

      1.  If written consent to the withholding or withdrawal of the treatment, attested by two witnesses, is given to the attending physician or attending advanced practice registered nurse, the attending physician or attending advanced practice registered nurse may withhold or withdraw life-sustaining treatment from a patient who:

      (a) Has been determined by the attending physician or attending advanced practice registered nurse to be in a terminal condition and no longer able to make decisions regarding administration of life-sustaining treatment; and

      (b) Has no effective declaration.

      2.  The authority to consent or to withhold consent under subsection 1 may be exercised by the following persons, in order of priority:

      (a) The spouse of the patient;

      (b) An adult child of the patient or, if there is more than one adult child, a majority of the adult children who are reasonably available for consultation;

      (c) The parents of the patient;

      (d) An adult sibling of the patient or, if there is more than one adult sibling, a majority of the adult siblings who are reasonably available for consultation; or

      (e) The nearest other adult relative of the patient by blood or adoption who is reasonably available for consultation.

      3.  If a class entitled to decide whether to consent is not reasonably available for consultation and competent to decide, or declines to decide, the next class is authorized to decide, but an equal division in a class does not authorize the next class to decide.

      4.  A decision to grant or withhold consent must be made in good faith. A consent is not valid if it conflicts with the expressed intention of the patient.

      5.  A decision of the attending physician or attending advanced practice registered nurse acting in good faith that a consent is valid or invalid is conclusive.

      6.  Life-sustaining treatment must not be withheld or withdrawn pursuant to this section from a patient known to the attending physician or attending advanced practice registered nurse to be pregnant so long as it is probable that the fetus will develop to the point of live birth with continued application of life-sustaining treatment.

      (Added to NRS by 1991, 631; A 2017, 1760) — (Substituted in revision for NRS 449.626)

      NRS 449A.457  Transfer of care of declarant.  An attending physician or other provider of health care who is unwilling to comply with NRS 449A.400 to 449A.481, inclusive, shall take all reasonable steps as promptly as practicable to transfer care of the declarant to another physician or provider of health care.

      (Added to NRS by 1991, 632) — (Substituted in revision for NRS 449.628)

      NRS 449A.460  Immunity from civil and criminal liability and discipline for unprofessional conduct.

      1.  A physician or other provider of health care is not subject to civil or criminal liability, or discipline for unprofessional conduct, for giving effect to a declaration or the direction of a person designated pursuant to NRS 449A.433 in the absence of knowledge of the revocation of a declaration, or for giving effect to a written consent under NRS 449A.454.

      2.  A physician or other provider of health care, whose action pursuant to NRS 449A.400 to 449A.481, inclusive, is in accord with reasonable medical standards, is not subject to civil or criminal liability, or discipline for unprofessional conduct, with respect to that action.

      3.  A physician or other provider of health care, whose decision about the validity of consent under NRS 449A.454 is made in good faith, is not subject to civil or criminal liability, or discipline for unprofessional conduct, with respect to that decision.

      4.  A person designated pursuant to NRS 449A.433 or a person authorized to consent pursuant to NRS 449A.454, whose decision is made or consent is given in good faith pursuant to NRS 449A.400 to 449A.481, inclusive, is not subject to civil or criminal liability, or discipline for unprofessional conduct, with respect to that decision.

      (Added to NRS by 1977, 760; A 1985, 1747; 1991, 635) — (Substituted in revision for NRS 449.630)

      NRS 449A.463  Consideration of declaration and other factors; failure to follow directions of patient.

      1.  If a patient in a terminal condition has a declaration in effect and becomes comatose or is otherwise rendered incapable of communicating with his or her attending physician or attending advanced practice registered nurse, the physician or advanced practice registered nurse must give weight to the declaration as evidence of the patient’s directions regarding the application of life-sustaining treatments, but the attending physician or attending advanced practice registered nurse may also consider other factors in determining whether the circumstances warrant following the directions.

      2.  No hospital or other medical facility, physician, advanced practice registered nurse or person working under the direction of a physician or advanced practice registered nurse is subject to criminal or civil liability for failure to follow the directions of the patient to withhold or withdraw life-sustaining treatments.

      (Added to NRS by 1977, 761; A 1985, 1747; 1993, 2792; 2017, 1761) — (Substituted in revision for NRS 449.640)

      NRS 449A.466  Assumption of validity of declaration; presumption of intent to use, withhold or withdraw life-sustaining treatment not created.

      1.  Unless he or she has knowledge to the contrary, a physician or other provider of health care may assume that a declaration complies with NRS 449A.400 to 449A.481, inclusive, and is valid.

      2.  NRS 449A.400 to 449A.481, inclusive, create no presumption concerning the intention of a person who has revoked or has not executed a declaration with respect to the use, withholding or withdrawal of life-sustaining treatment in the event of a terminal condition.

      (Added to NRS by 1991, 632) — (Substituted in revision for NRS 449.645)

      NRS 449A.469  Death does not constitute suicide or homicide; effect of declaration on policy of insurance; prohibiting or requiring execution of declaration prohibited as condition for insurance or receipt of health care.

      1.  Death resulting from the withholding or withdrawal of life-sustaining treatment in accordance with NRS 449A.400 to 449A.481, inclusive, does not constitute, for any purpose, a suicide or homicide.

      2.  The making of a declaration pursuant to NRS 449A.433 does not affect the sale, procurement or issuance of a policy of life insurance or annuity, nor does it affect, impair or modify the terms of an existing policy of life insurance or annuity. A policy of life insurance or annuity is not legally impaired or invalidated by the withholding or withdrawal of life-sustaining treatment from an insured, notwithstanding any term to the contrary.

      3.  A person may not prohibit or require the execution of a declaration as a condition for being insured for, or receiving, health care.

      (Added to NRS by 1977, 761; A 1991, 636) — (Substituted in revision for NRS 449.650)

      NRS 449A.472  Penalties.

      1.  A physician or other provider of health care who willfully fails to transfer the care of a patient in accordance with NRS 449A.457 is guilty of a gross misdemeanor.

      2.  A physician or advanced practice registered nurse who willfully fails to record a determination of terminal condition or the terms of a declaration in accordance with NRS 449A.448 is guilty of a misdemeanor.

      3.  A person who willfully conceals, cancels, defaces or obliterates the declaration of another without the declarant’s consent or who falsifies or forges a revocation of the declaration of another is guilty of a misdemeanor.

      4.  A person who falsifies or forges the declaration of another, or willfully conceals or withholds personal knowledge of a revocation, with the intent to cause a withholding or withdrawal of life-sustaining treatment contrary to the wishes of the declarant and thereby directly causes life-sustaining treatment to be withheld or withdrawn and death to be hastened is guilty of murder.

      5.  A person who requires or prohibits the execution of a declaration as a condition of being insured for, or receiving, health care is guilty of a misdemeanor.

      6.  A person who coerces or fraudulently induces another to execute a declaration, or who falsifies or forges the declaration of another except as provided in subsection 4, is guilty of a gross misdemeanor.

      7.  The penalties provided in this section do not displace any sanction applicable under other law.

      (Added to NRS by 1977, 761; A 1991, 636; 2017, 1761) — (Substituted in revision for NRS 449.660)

      NRS 449A.475  Actions contrary to reasonable medical standards not required; mercy-killing, assisted suicide or euthanasia not authorized.

      1.  NRS 449A.400 to 449A.481, inclusive, do not require a physician or other provider of health care to take action contrary to reasonable medical standards.

      2.  NRS 449A.400 to 449A.481, inclusive, do not condone, authorize or approve mercy-killing, assisted suicide or euthanasia.

      (Added to NRS by 1977, 761; A 1991, 637; 1995, 1794) — (Substituted in revision for NRS 449.670)

      NRS 449A.478  Other right or responsibility regarding use of life-sustaining treatment or withholding or withdrawal of medical care not limited.  NRS 449A.400 to 449A.481, inclusive, do not affect the right of a patient to make decisions regarding use of life-sustaining treatment, so long as the patient is able to do so, or impair or supersede a right or responsibility that any person has to effect the withholding or withdrawal of medical care.

      (Added to NRS by 1977, 761; A 1991, 637) — (Substituted in revision for NRS 449.680)

      NRS 449A.481  Validity of declaration executed in another state; effect of previously executed instrument.

      1.  A declaration executed in another state in compliance with the law of that state or of this State is valid for purposes of NRS 449A.400 to 449A.481, inclusive.

      2.  An instrument executed anywhere before July 1, 1977, which clearly expresses the intent of the declarant to direct the withholding or withdrawal of life-sustaining treatment from the declarant when the declarant is in a terminal condition and becomes comatose or is otherwise rendered incapable of communicating with his or her attending physician or attending advanced practice registered nurse, if executed in a manner which attests voluntary execution, or executed anywhere before October 1, 1991, which substantially complies with NRS 449A.433, and has not been subsequently revoked, is effective under NRS 449A.400 to 449A.481, inclusive.

      3.  As used in this section, “state” includes the District of Columbia, the Commonwealth of Puerto Rico, and a territory or insular possession subject to the jurisdiction of the United States.

      (Added to NRS by 1977, 761; A 1991, 637; 2017, 1761) — (Substituted in revision for NRS 449.690)

PROVIDER ORDERS FOR LIFE-SUSTAINING TREATMENT

      NRS 449A.500  Definitions.  As used in NRS 449A.500 to 449A.581, inclusive, unless the context otherwise requires, the words and terms defined in NRS 449A.503 to 449A.545, inclusive, have the meanings ascribed to them in those sections.

      (Added to NRS by 2013, 2284; A 2017, 456, 1762) — (Substituted in revision for NRS 449.691)

      NRS 449A.503  “Advanced practice registered nurse” defined.  “Advanced practice registered nurse” has the meaning ascribed to it in NRS 449A.406.

      (Added to NRS by 2017, 456, 1757)

      NRS 449A.506  “Attending advanced practice registered nurse” defined.  “Attending advanced practice registered nurse” has the meaning ascribed to it in NRS 449A.409.

      (Added to NRS by 2017, 456, 1757)

      NRS 449A.509  “Attending physician” defined.  “Attending physician” has the meaning ascribed to it in NRS 449A.412.

      (Added to NRS by 2013, 2284) — (Substituted in revision for NRS 449.6912)

      NRS 449A.512  “Attending physician assistant” defined.  “Attending physician assistant” means a physician assistant who has primary responsibility for the treatment and care of the patient.

      (Added to NRS by 2017, 456)

      NRS 449A.515  “Do-not-resuscitate identification” defined.  “Do-not-resuscitate identification” has the meaning ascribed to it in NRS 450B.410.

      (Added to NRS by 2013, 2284) — (Substituted in revision for NRS 449.6915)

      NRS 449A.518  “Do-not-resuscitate order” defined.  “Do-not-resuscitate order” has the meaning ascribed to it in NRS 450B.420.

      (Added to NRS by 2013, 2284) — (Substituted in revision for NRS 449.6916)

      NRS 449A.521  “Emergency care” defined.  “Emergency care” means the use of life-resuscitating treatment and other immediate treatment provided in response to a sudden, acute and unanticipated medical emergency in order to avoid injury, impairment or death.

      (Added to NRS by 2013, 2284) — (Substituted in revision for NRS 449.6918)

      NRS 449A.524  “Health care facility” defined.  “Health care facility” has the meaning ascribed to it in NRS 162A.740.

      (Added to NRS by 2013, 2284) — (Substituted in revision for NRS 449.692)

      NRS 449A.527  “Life-resuscitating treatment” defined.  “Life-resuscitating treatment” has the meaning ascribed to it in NRS 450B.450.

      (Added to NRS by 2013, 2284) — (Substituted in revision for NRS 449.6924)

      NRS 449A.530  “Life-sustaining treatment” defined.  “Life-sustaining treatment” has the meaning ascribed to it in NRS 449A.418.

      (Added to NRS by 2013, 2284) — (Substituted in revision for NRS 449.6925)

      NRS 449A.533  “Other types of advance directives” defined.  “Other types of advance directives” means an advance directive as defined in NRS 449A.703, but does not include a POLST form.

      (Added to NRS by 2013, 2284) — (Substituted in revision for NRS 449.6928)

      NRS 449A.536  “Physician assistant” defined.  “Physician assistant” means a person who holds a license as a physician assistant pursuant to chapter 630 or 633 of NRS.

      (Added to NRS by 2017, 456)

      NRS 449A.539  “Provider of health care” defined.  “Provider of health care” means an individual who is licensed, certified or otherwise authorized or allowed by law to provide health care in the ordinary course of business or practice of a profession, and includes a person who:

      1.  Is described in NRS 629.031; or

      2.  Administers emergency medical services as defined in NRS 450B.460.

      (Added to NRS by 2013, 2284) — (Substituted in revision for NRS 449.6932)

      NRS 449A.542  “Provider Order for Life-Sustaining Treatment form” or “POLST form” defined.  “Provider Order for Life-Sustaining Treatment form” or “POLST form” means the form prescribed pursuant to NRS 449A.548 that:

      1.  Records the wishes of the patient; and

      2.  Directs a provider of health care regarding the provision of life-resuscitating treatment and life-sustaining treatment.

      (Added to NRS by 2013, 2284; A 2017, 456, 1762) — (Substituted in revision for NRS 449.693)

      NRS 449A.545  “Representative of the patient” defined.  “Representative of the patient” means a legal guardian of the patient, a person designated by the patient to make decisions governing the withholding or withdrawal of life-sustaining treatment pursuant to NRS 449A.433 or a person given power of attorney to make decisions concerning health care for the patient pursuant to NRS 162A.700 to 162A.865, inclusive.

      (Added to NRS by 2013, 2285) — (Substituted in revision for NRS 449.6934)

      NRS 449A.548  Board to prescribe standardized POLST form; requirements.  The Board shall prescribe a standardized Provider Order for Life-Sustaining Treatment form, commonly known as a POLST form, which:

      1.  Is uniquely identifiable and has a uniform color;

      2.  Provides a means by which to indicate whether the patient has made an anatomical gift pursuant to NRS 451.500 to 451.598, inclusive;

      3.  Gives direction to a provider of health care or health care facility regarding the use of emergency care and life-sustaining treatment;

      4.  Is intended to be honored by any provider of health care who treats the patient in any health-care setting, including, without limitation, the patient’s residence, a health care facility or the scene of a medical emergency; and

      5.  Includes such other features and information as the Board may deem advisable.

      (Added to NRS by 2013, 2285; A 2017, 456, 1762) — (Substituted in revision for NRS 449.694)

      NRS 449A.551  Explanation of POLST form to patient; completion of form; validity of form; actions authorized for patient who regains capacity.

      1.  A physician, physician assistant or advanced practice registered nurse shall take the actions described in subsection 2:

      (a) If the physician, physician assistant or advanced practice registered nurse diagnoses a patient with a terminal condition;

      (b) If the physician, physician assistant or advanced practice registered nurse determines, for any reason, that a patient has a life expectancy of less than 5 years; or

      (c) At the request of a patient.

      2.  Upon the occurrence of any of the events specified in subsection 1, the physician, physician assistant or advanced practice registered nurse shall explain to the patient:

      (a) The existence and availability of the Provider Order for Life-Sustaining Treatment form;

      (b) The features of and procedures offered by way of the POLST form; and

      (c) The differences between a POLST form and the other types of advance directives.

      3.  The physician, physician assistant or advanced practice registered nurse shall complete the POLST form based on the preferences and medical indications of the patient, upon the request of:

      (a) If the patient is 18 years of age or older and the physician, physician assistant or advanced practice registered nurse determines that the patient has the capacity to make decisions regarding his or her wishes for the provision of life-resuscitating treatment and life-sustaining treatment, the patient.

      (b) If the patient is 18 years of age or older and the physician, physician assistant or advanced practice registered nurse determines that the patient lacks the capacity to make decisions regarding his or her wishes for the provision of life-resuscitating treatment and life-sustaining treatment:

             (1) The representative of the patient; or

             (2) If no person is a representative of the patient and a valid POLST form has not been executed by the patient or the representative of the patient, a surrogate of the patient who has the capacity to make decisions regarding the provision of life-resuscitating treatment and life-sustaining treatment for the patient.

      (c) If the patient is less than 18 years of age, the patient and a parent or legal guardian of the patient.

      4.  A POLST form is valid upon execution by a physician, physician assistant or advanced practice registered nurse and:

      (a) If the patient is 18 years of age or older and the physician, physician assistant or advanced practice registered nurse determines that the patient has the capacity to make decisions regarding his or her wishes for the provision of life-resuscitating treatment and life-sustaining treatment, the patient.

      (b) If the patient is 18 years of age or older and the physician, physician assistant or advanced practice registered nurse determines that the patient lacks the capacity to make decisions regarding his or her wishes for the provision of life-resuscitating treatment and life-sustaining treatment:

             (1) The representative of the patient; or

             (2) If no person is a representative of the patient and a valid POLST form has not been executed by the patient or the representative of the patient, a surrogate of the patient who has the capacity to make decisions regarding the provision of life-resuscitating treatment and life-sustaining treatment for the patient.

      (c) If the patient is less than 18 years of age, a parent or legal guardian of the patient.

      5.  If, pursuant to subsection 3, a valid POLST form has been executed by a representative or surrogate of the patient and a provider of health care or the representative or surrogate of the patient believes that the patient has regained the capacity to make decisions regarding his or her wishes for the provision of life-resuscitating treatment and life-sustaining treatment, a physician, physician assistant or advanced practice registered nurse must examine the patient and inform the patient of the execution of the POLST form. If the physician, physician assistant or advanced practice registered nurse determines that the patient regained the capacity to make decisions regarding his or her wishes for the provision of life-resuscitating treatment and life-sustaining treatment, the patient may approve the execution of the POLST form or, pursuant to NRS 449A.554, revoke the POLST form executed for the patient by his or her representative or surrogate. If the patient approves the execution of the POLST form executed by his or her representative or surrogate, such approval must be made a part of the medical record of the patient and the POLST form is deemed to be valid. The physician, physician assistant or advanced practice registered nurse who examined the patient must notify the representative or surrogate of the patient who executed the POLST form of the decision of the patient to approve or revoke the POLST form.

      6.  For the purpose of determining whether a surrogate of the patient is authorized to request and execute a POLST form pursuant to subsections 3 and 4, respectively:

      (a) If a class entitled to decide whether to request and execute a POLST form is not reasonably available for consultation and capable of deciding or declines to decide, the next class is authorized to decide, but an equal division in a class does not authorize the next class to decide.

      (b) A decision to request and execute a POLST form must be made in good faith and is not valid if it conflicts with the expressed intention of the patient.

      (c) A decision of the physician, physician assistant or advanced practice registered nurse acting in good faith that a decision to request and execute a POLST form is valid or invalid is conclusive.

      7.  As used in this section:

      (a) “Surrogate of the patient” means the following persons, in order of priority:

             (1) The spouse of the patient;

             (2) An adult child of the patient or, if there is more than one adult child, a majority of the adult children who are reasonably available for consultation;

             (3) The parents of the patient;

             (4) An adult sibling of the patient or, if there is more than one adult sibling, a majority of the adult siblings who are reasonably available for consultation;

             (5) The nearest other adult relative of the patient by blood or adoption who is reasonably available for consultation; or

             (6) An adult who has exhibited special care or concern for the patient, is familiar with the values of the patient and willing and able to make health care decisions for the patient.

      (b) “Terminal condition” has the meaning ascribed to it in NRS 449A.430.

      (Added to NRS by 2013, 2285; A 2017, 456, 1762, 3921) — (Substituted in revision for NRS 449.6942)

      NRS 449A.554  Revocation of POLST form; entry of revocation in medical records of patient.

      1.  A Provider Order for Life-Sustaining Treatment form may be revoked at any time and in any manner by:

      (a) The patient who executed it or for whom a representative or surrogate executed it pursuant to NRS 449A.551, if the patient is 18 years of age or older and the physician, physician assistant or advanced practice registered nurse determines that the patient has the capacity to make decisions regarding his or her wishes for the provision of life-resuscitating treatment and life-sustaining treatment;

      (b) Without regard to the patient’s age or physical condition, if the physician, physician assistant or advanced practice registered nurse determines that the patient lacks the capacity to make decisions regarding his or her wishes for the provision of life-resuscitating treatment and life-sustaining treatment, the representative of the patient; or

      (c) If the patient is less than 18 years of age, a parent or legal guardian of the patient.

      2.  The revocation of a POLST form is effective upon the communication to a provider of health care, by the patient or a person authorized to revoke a POLST form pursuant to subsection 1, of the desire to revoke the form. The provider of health care to whom the revocation is communicated shall:

      (a) Make the revocation a part of the medical record of the patient; or

      (b) Cause the revocation to be made a part of the medical record of the patient.

      (Added to NRS by 2013, 2285; A 2017, 459, 1763, 3922) — (Substituted in revision for NRS 449.6944)

      NRS 449A.557  Conflict with other advance directive or do-not-resuscitate identification.

      1.  If a valid Provider Order for Life-Sustaining Treatment form sets forth a declaration, direction or order which conflicts with a declaration, direction or order set forth in one or more of the other types of advance directives:

      (a) The declaration, direction or order set forth in the document executed most recently is valid; and

      (b) Any other declarations, directions or orders that do not conflict with a declaration, direction or order set forth in another document referenced in this subsection remain valid.

      2.  If a valid POLST form sets forth a declaration, direction or order to provide life-resuscitating treatment to a patient who also possesses a do-not-resuscitate identification, a provider of health care shall provide life-resuscitating treatment if the declaration, direction or order to provide life-resuscitating treatment set forth in the valid POLST form was executed more recently than the issuance of the do-not-resuscitate identification.

      (Added to NRS by 2013, 2286; A 2017, 459, 1763) — (Substituted in revision for NRS 449.6946)

      NRS 449A.560  Immunity from civil and criminal liability and from discipline for unprofessional conduct.

      1.  A provider of health care is not guilty of unprofessional conduct or subject to civil or criminal liability if:

      (a) The provider of health care withholds emergency care or life-sustaining treatment:

             (1) In compliance with a Provider Order for Life-Sustaining Treatment form and the provisions of NRS 449A.500 to 449A.581, inclusive; or

             (2) In violation of a Provider Order for Life-Sustaining Treatment form if the provider of health care is acting in accordance with a declaration, direction or order set forth in one or more of the other types of advance directives and:

                   (I) Complies with the provisions of NRS 449A.563; or

                   (II) Reasonably and in good faith, at the time the emergency care or life-sustaining treatment is withheld, is unaware of the existence of the POLST form or believes that the POLST form has been revoked pursuant to NRS 449A.554; or

      (b) The provider of health care provides emergency care or life-sustaining treatment:

             (1) Pursuant to an oral or written request made by the patient, the representative of the patient, or a parent or legal guardian of the patient, who may revoke the POLST form pursuant to NRS 449A.554;

             (2) Pursuant to an observation that the patient, the representative of the patient or a parent or legal guardian of the patient has revoked, or otherwise indicated that he or she wishes to revoke, the POLST form pursuant to NRS 449A.554; or

             (3) In violation of a POLST form, if the provider of health care reasonably and in good faith, at the time the emergency care or life-sustaining treatment is provided, is unaware of the existence of the POLST form or believes that the POLST form has been revoked pursuant to NRS 449A.554.

      2.  A health care facility, ambulance service, fire-fighting agency or other entity that employs a provider of health care is not guilty of unprofessional conduct or subject to civil or criminal liability for the acts or omissions of the employee carried out in accordance with the provisions of subsection 1.

      (Added to NRS by 2013, 2286; A 2017, 459, 1763) — (Substituted in revision for NRS 449.6948)

      NRS 449A.563  Provider of health care required to comply with valid POLST form; modification by provider; transfer of care of patient; exceptions.

      1.  Except as otherwise provided in this section and NRS 449A.557, a provider of health care shall comply with a valid Provider Order for Life-Sustaining Treatment form, regardless of whether the provider of health care is employed by a health care facility or other entity affiliated with the physician, physician assistant or advanced practice registered nurse who executed the POLST form.

      2.  A physician, physician assistant or advanced practice registered nurse may medically evaluate the patient and, based upon the evaluation, may recommend new orders consistent with the most current information available about the patient’s health status and goals of care. Before making a modification to a valid POLST form, the physician, physician assistant or advanced practice registered nurse shall consult the patient or, if the patient lacks decisional capacity, shall make a reasonable attempt to consult the representative of the patient and the patient’s attending physician, attending physician assistant or attending advanced practice registered nurse.

      3.  Except as otherwise provided in subsection 4, a provider of health care who is unwilling or unable to comply with a valid POLST form shall take all reasonable measures to transfer the patient to a physician, physician assistant, advanced practice registered nurse or health care facility so that the POLST form will be followed.

      4.  Life-sustaining treatment must not be withheld or withdrawn pursuant to a POLST form of a patient known to the attending physician, attending physician assistant or attending advanced practice registered nurse to be pregnant, so long as it is probable that the fetus will develop to the point of live birth with the continued application of life-sustaining treatment.

      5.  Nothing in this section requires a provider of health care to comply with a valid POLST form if the provider of health care does not have actual knowledge of the existence of the form.

      (Added to NRS by 2013, 2287; A 2017, 460, 1764, 3922) — (Substituted in revision for NRS 449.695)

      NRS 449A.566  Assumption of validity of POLST form; presumption of intent of patient not created if patient has revoked or not executed POLST form.

      1.  Unless he or she has knowledge to the contrary, a provider of health care may assume that a Provider Order for Life-Sustaining Treatment form complies with the provisions of NRS 449A.500 to 449A.581, inclusive, and is valid.

      2.  The provisions of NRS 449A.500 to 449A.581, inclusive, do not create a presumption concerning the intention of a:

      (a) Patient if the patient, the representative of the patient or a parent or legal guardian of the patient has revoked the POLST form pursuant to NRS 449A.554; or

      (b) Person who has not executed a POLST form,

Ê concerning the use or withholding of emergency care or life-sustaining treatment.

      (Added to NRS by 2013, 2287; A 2017, 461, 1765) — (Substituted in revision for NRS 449.6952)

      NRS 449A.569  Death does not constitute suicide or homicide; effect of POLST form on policy of insurance; prohibiting or requiring execution of POLST form prohibited as condition for insurance or receipt of health care.

      1.  Death that results when emergency care or life-sustaining treatment has been withheld pursuant to a Provider Order for Life-Sustaining Treatment form and in accordance with the provisions of NRS 449A.500 to 449A.581, inclusive, does not constitute a suicide or homicide.

      2.  The execution of a POLST form does not affect the sale, procurement or issuance of a policy of life insurance or an annuity, nor does it affect, impair or modify the terms of an existing policy of life insurance or an annuity. A policy of life insurance or an annuity is not legally impaired or invalidated if emergency care or life-sustaining treatment has been withheld from an insured who has executed a POLST form, notwithstanding any term in the policy or annuity to the contrary.

      3.  A person may not prohibit or require the execution of a POLST form as a condition of being insured for, or receiving, health care.

      (Added to NRS by 2013, 2287; A 2017, 461, 1765) — (Substituted in revision for NRS 449.6954)

      NRS 449A.572  Unlawful acts; penalty.

      1.  It is unlawful for:

      (a) A provider of health care to willfully fail to transfer the care of a patient in accordance with subsection 3 of NRS 449A.563.

      (b) A person to willfully conceal, cancel, deface or obliterate a Provider Order for Life-Sustaining Treatment form without the consent of the patient who executed the form.

      (c) A person to falsify or forge the POLST form of another person, or willfully conceal or withhold personal knowledge of the revocation of the POLST form of another person, with the intent to cause the withholding or withdrawal of emergency care or life-sustaining treatment contrary to the wishes of the patient.

      (d) A person to require or prohibit the execution of a POLST form as a condition of being insured for, or receiving, health care in violation of subsection 3 of NRS 449A.569.

      (e) A person to coerce or fraudulently induce another to execute a POLST form.

      2.  A person who violates any of the provisions of this section is guilty of a misdemeanor.

      (Added to NRS by 2013, 2288; A 2017, 461, 1765) — (Substituted in revision for NRS 449.6956)

      NRS 449A.575  Actions contrary to reasonable medical standards not required; mercy-killing, euthanasia or assisted suicide not authorized; rights associated with other advance directives not impaired; right to make decisions concerning emergency care or life-sustaining treatment not affected.  The provisions of NRS 449A.500 to 449A.581, inclusive, do not:

      1.  Require a provider of health care to take any action contrary to reasonable medical standards;

      2.  Affect the responsibility of a provider of health care to provide treatment for a patient’s comfort or alleviation of pain;

      3.  Condone, authorize or approve mercy killing, euthanasia or assisted suicide;

      4.  Except as otherwise provided in NRS 449A.557, affect or impair any right created pursuant to the provisions of any other types of advance directives; or

      5.  Affect the right of a patient to make decisions concerning the use of emergency care or life-sustaining treatment, if he or she is able to do so.

      (Added to NRS by 2013, 2288) — (Substituted in revision for NRS 449.6958)

      NRS 449A.578  Validity of POLST form executed in another state.

      1.  A Provider Order for Life-Sustaining Treatment form executed in another state in compliance with the laws of that state or this State is valid for the purposes of NRS 449A.500 to 449A.581, inclusive.

      2.  As used in this section, “state” includes the District of Columbia, the Commonwealth of Puerto Rico and a territory or insular possession subject to the jurisdiction of the United States.

      (Added to NRS by 2013, 2288; A 2017, 462, 1766) — (Substituted in revision for NRS 449.696)

      NRS 449A.581  Regulations.  The Board may adopt such regulations as it determines to be necessary or advisable to carry out the provisions of NRS 449A.500 to 449A.581, inclusive.

      (Added to NRS by 2013, 2288) — (Substituted in revision for NRS 449.697)

ADVANCE DIRECTIVES FOR PSYCHIATRIC CARE

      NRS 449A.600  Definitions.  As used in NRS 449A.600 to 449A.645, inclusive, unless the context otherwise requires, the words and terms defined in NRS 449A.603 to 449A.615, inclusive, have the meanings ascribed to them in those sections.

      (Added to NRS by 2017, 690)

      NRS 449A.603  “Advance directive for psychiatric care” or “advance directive” defined.  “Advance directive for psychiatric care” or “advance directive” means a writing executed in accordance with the requirements of NRS 449A.618 pursuant to which the principal makes a declaration of instructions, information and preferences regarding his or her psychiatric care.

      (Added to NRS by 2017, 690)

      NRS 449A.606  “Attending physician” defined.  “Attending physician” has the meaning ascribed to it in NRS 449A.412.

      (Added to NRS by 2017, 690)

      NRS 449A.609  “Principal” defined.  “Principal” means the person who has executed an advance directive for psychiatric care.

      (Added to NRS by 2017, 690)

      NRS 449A.612  “Provider of health care” defined.  “Provider of health care” has the meaning ascribed to it in NRS 449A.424.

      (Added to NRS by 2017, 690)

      NRS 449A.615  “Psychiatric care” defined.  “Psychiatric care” means the provision of psychiatric services and psychiatric treatment and the administration of psychotropic medication.

      (Added to NRS by 2017, 690)

      NRS 449A.618  Execution of advance directive; period of effectiveness.

      1.  A person of sound mind who is 18 or more years of age or who has been declared emancipated pursuant to NRS 129.080 to 129.140, inclusive, may execute at any time an advance directive for psychiatric care. The principal may designate another natural person of sound mind and 18 or more years of age to make decisions governing the provision of psychiatric care. The advance directive must be signed by the principal, or another at the principal’s direction, and attested by two witnesses. Neither of the witnesses may be:

      (a) The attending physician or provider of health care;

      (b) An employee of the attending physician or provider of health care;

      (c) An owner or operator of a medical facility in which the principal is a patient or resident or an employer of such an owner or operator; or

      (d) A person appointed as an attorney-in-fact by the advance directive.

      2.  An advance directive becomes effective upon its proper execution and remains valid for a period of 2 years after the date of its execution unless revoked.

      (Added to NRS by 2017, 690)

      NRS 449A.621  Form.  The form of an advance directive for psychiatric care may be substantially in the following form, and must be witnessed or executed in the same manner as the following form:

 

NOTICE TO PERSON MAKING AN ADVANCE DIRECTIVE FOR PSYCHIATRIC CARE

 

       THIS IS AN IMPORTANT LEGAL DOCUMENT. IT CREATES AN ADVANCE DIRECTIVE FOR PSYCHIATRIC CARE. BEFORE SIGNING THIS DOCUMENT YOU SHOULD KNOW THESE IMPORTANT FACTS:

       THIS DOCUMENT ALLOWS YOU TO MAKE DECISIONS IN ADVANCE ABOUT CERTAIN TYPES OF PSYCHIATRIC CARE. THE INSTRUCTIONS YOU INCLUDE IN THIS ADVANCE DIRECTIVE WILL BE FOLLOWED IF TWO PROVIDERS OF HEALTH CARE, ONE OF WHOM MUST BE A PHYSICIAN OR LICENSED PSYCHOLOGIST AND THE OTHER OF WHOM MUST BE A PHYSICIAN, A PHYSICIAN ASSISTANT, A LICENSED PSYCHOLOGIST, A PSYCHIATRIST OR AN ADVANCED PRACTICE REGISTERED NURSE WHO HAS THE PSYCHIATRIC TRAINING AND EXPERIENCE PRESCRIBED BY THE STATE BOARD OF NURSING PURSUANT TO NRS 632.120, DETERMINES THAT YOU ARE INCAPABLE OF MAKING OR COMMUNICATING TREATMENT DECISIONS. OTHERWISE YOU WILL BE CONSIDERED CAPABLE TO GIVE OR WITHHOLD CONSENT FOR THE TREATMENTS. YOUR INSTRUCTIONS MAY BE OVERRIDDEN IF YOU ARE BEING HELD IN ACCORDANCE WITH CIVIL COMMITMENT LAW. BY EXECUTING A DURABLE POWER OF ATTORNEY FOR HEALTH CARE AS SET FORTH IN NRS 162A.700 TO 162A.865, INCLUSIVE, YOU MAY ALSO APPOINT A PERSON AS YOUR AGENT TO MAKE TREATMENT DECISIONS FOR YOU IF YOU BECOME INCAPABLE. THIS DOCUMENT IS VALID FOR TWO YEARS FROM THE DATE YOU EXECUTE IT UNLESS YOU REVOKE IT. YOU HAVE THE RIGHT TO REVOKE THIS DOCUMENT AT ANY TIME YOU HAVE NOT BEEN DETERMINED TO BE INCAPABLE. YOU MAY NOT REVOKE THIS ADVANCE DIRECTIVE WHEN YOU ARE FOUND INCAPABLE BY TWO PROVIDERS OF HEALTH CARE, ONE OF WHOM MUST BE A PHYSICIAN OR LICENSED PSYCHOLOGIST AND THE OTHER OF WHOM MUST BE A PHYSICIAN, A PHYSICIAN ASSISTANT, A LICENSED PSYCHOLOGIST, A PSYCHIATRIST OR AN ADVANCED PRACTICE REGISTERED NURSE WHO HAS THE PSYCHIATRIC TRAINING AND EXPERIENCE PRESCRIBED BY THE STATE BOARD OF NURSING PURSUANT TO NRS 632.120. A REVOCATION IS EFFECTIVE WHEN IT IS COMMUNICATED TO YOUR ATTENDING PHYSICIAN OR OTHER HEALTH CARE PROVIDER. THE PHYSICIAN OR OTHER PROVIDER SHALL NOTE THE REVOCATION IN YOUR MEDICAL RECORD. TO BE VALID, THIS ADVANCE DIRECTIVE MUST BE SIGNED BY TWO QUALIFIED WITNESSES, PERSONALLY KNOWN TO YOU, WHO ARE PRESENT WHEN YOU SIGN OR ACKNOWLEDGE YOUR SIGNATURE. IT MUST ALSO BE ACKNOWLEDGED BEFORE A NOTARY PUBLIC.

 

NOTICE TO PHYSICIAN OR OTHER PROVIDER OF HEALTH CARE

 

       Under Nevada law, a person may use this advance directive to provide consent or refuse to consent to future psychiatric care if the person later becomes incapable of making or communicating those decisions. By executing a durable power of attorney for health care as set forth in NRS 162A.700 to 162A.865, inclusive, the person may also appoint an agent to make decisions regarding psychiatric care for the person when incapable. A person is “incapable” for the purposes of this advance directive when in the opinion of two providers of health care, one of whom must be a physician or licensed psychologist and the other of whom must be a physician, a physician assistant, a licensed psychologist, a psychiatrist or an advanced practice registered nurse who has the psychiatric training and experience prescribed by the State Board of Nursing pursuant to NRS 632.120, the person currently lacks sufficient understanding or capacity to make or communicate decisions regarding psychiatric care. If a person is determined to be incapable, the person may be found capable when, in the opinion of the person’s attending physician or an advanced practice registered nurse who has the psychiatric training and experience prescribed by the State Board of Nursing pursuant to NRS 632.120 and has an established relationship with the person, the person has regained sufficient understanding or capacity to make or communicate decisions regarding psychiatric care. This document becomes effective upon its proper execution and remains valid for a period of 2 years after the date of its execution unless revoked. Upon being presented with this advance directive, the physician or other provider of health care must make it a part of the person’s medical record. The physician or other provider must act in accordance with the statements expressed in the advance directive when the person is determined to be incapable, except as otherwise provided in NRS 449A.636. The physician or other provider shall promptly notify the principal and, if applicable, the agent of the principal, and document in the principal’s medical record any act or omission that is not in compliance with any part of an advance directive. A physician or other provider may rely upon the authority of a signed, witnessed, dated and notarized advance directive.

 

ADVANCE DIRECTIVE FOR PSYCHIATRIC CARE

 

       I, .............................., being an adult of sound mind or an emancipated minor, willfully and voluntarily make this advance directive for psychiatric care to be followed if it is determined by two providers of health care, one of whom must be my attending physician or a licensed psychologist and the other of whom must be a physician, a physician assistant, a licensed psychologist, a psychiatrist or an advanced practice registered nurse who has the psychiatric training and experience prescribed by the State Board of Nursing pursuant to NRS 632.120, that my ability to receive and evaluate information effectively or communicate decisions is impaired to such an extent that I lack the capacity to refuse or consent to psychiatric care. I understand that psychiatric care may not be administered without my express and informed consent or, if I am incapable of giving my informed consent, the express and informed consent of my legally responsible person, my agent named pursuant to a valid durable power of attorney for health care or my consent expressed in this advance directive for psychiatric care. I understand that I may become incapable of giving or withholding informed consent or refusal for psychiatric care due to the symptoms of a diagnosed mental disorder. These symptoms may include:

..........................................................................................................................................

 

PSYCHOACTIVE MEDICATIONS

 

       If I become incapable of giving or withholding informed consent for psychiatric care, my instructions regarding psychoactive medications are as follows: (Place initials beside choice.)

       I consent to the administration of the following medications:  [.................... ]

..........................................................................................................................................

       I do not consent to the administration of the following medications:........... [        ]

..........................................................................................................................................

       Conditions or limitations:

..........................................................................................................................................

 

ADMISSION TO AND RETENTION IN FACILITY

 

       If I become incapable of giving or withholding informed consent for psychiatric care, my instructions regarding admission to and retention in a medical facility for psychiatric care are as follows: (Place initials beside choice.)

       I consent to being admitted to a medical facility for psychiatric care............ [        ]

       My facility preference is:

..........................................................................................................................................

       I do not consent to being admitted to a medical facility for psychiatric care........ [               ]

       This advance directive cannot, by law, provide consent to retain me in a facility beyond the specific number of days, if any, provided in this advance directive.

       Conditions or limitations:

..........................................................................................................................................

 

ADDITIONAL INSTRUCTIONS

 

       These instructions shall apply during the entire length of my incapacity.

       In case of a mental health crisis, please contact:

       1.

Name: ........................................................................

Address: ...................................................................

Home Telephone Number: .....................................

Work Telephone Number: .....................................

Relationship to Me: ................................................

       2.

Name: ........................................................................

Address: ...................................................................

Home Telephone Number: .....................................

Work Telephone Number: .....................................

Relationship to Me: ................................................

       3.  My physician:

Name: ..................................................................

Work Telephone Number: ...............................

       4.  My therapist or counselor:

Name: ..................................................................

Work Telephone Number: ...............................

       The following may cause me to experience a mental health crisis:

..........................................................................................................................................

       The following may help me avoid a hospitalization:

..........................................................................................................................................

       I generally react to being hospitalized as follows:

..........................................................................................................................................

       Staff of the hospital or crisis unit can help me by doing the following:

..........................................................................................................................................

       I give permission for the following person or people to visit me:

..........................................................................................................................................

       Instructions concerning any other medical interventions, such as electroconvulsive (ECT) treatment (commonly referred to as “shock treatment”):

..........................................................................................................................................

       Other instructions:

..........................................................................................................................................

       I have attached an additional sheet of instructions to be followed and considered part of this advance directive.                                                                                                   [.................... ]

 

SHARING OF INFORMATION BY PROVIDERS

 

       I understand that the information in this document may be shared by my provider of mental health care with any other provider who may serve me when necessary to provide treatment in accordance with this advance directive.

       Other instructions about sharing of information:

..........................................................................................................................................

 

SIGNATURE OF PRINCIPAL

 

       By signing here, I indicate that I am mentally alert and competent, fully informed as to the contents of this document, and understand the full impact of having made this advance directive for psychiatric care.

                                                   .......................................................         .......................

                                                            Signature of Principal                         Date

 

AFFIRMATION OF WITNESSES

 

       We affirm that the principal is personally known to us, that the principal signed or acknowledged the principal’s signature on this advance directive for psychiatric care in our presence, that the principal appears to be of sound mind and not under duress, fraud, or undue influence, and that neither of us is:

       1.  A person appointed as an attorney-in-fact by this document;

       2.  The principal’s attending physician or provider of health care or an employee of the physician or provider; or

       3.  The owner or operator, or employee of the owner or operator, of a medical facility in which the principal is a patient or resident.

       Witnessed by:

Witness: ...................................................................                 .......................

                                                         Signature                                                 Date

Witness: ...................................................................                 .......................

                                                         Signature                                                 Date

 

STATE OF NEVADA

COUNTY OF.................................

 

CERTIFICATION OF NOTARY PUBLIC

 

STATE OF NEVADA

COUNTY OF.................................

 

       I, .............................., a Notary Public for the County cited above in the State of Nevada, hereby certify that .............................. appeared before me and swore or affirmed to me and to the witnesses in my presence that this instrument is an advance directive for psychiatric care and that he or she willingly and voluntarily made and executed it as his or her free act and deed for the purposes expressed in it.

       I further certify that .............................. and .............................., witnesses, appeared before me and swore or affirmed that each witnessed .............................. sign the attached advance directive for psychiatric care believing him or her to be of sound mind and also swore that at the time each witnessed the signing, each person was: (1) not the attending physician or provider of health care, or an employee of the physician or provider, of the principal; (2) not the owner or operator, or employee of the owner or operator, of a medical facility in which the principal is a patient or resident; and (3) not a person appointed as an attorney-in-fact by the attached advance directive for psychiatric care. I further certify that I am satisfied as to the genuineness and due execution of the instrument.

       This is the .......... day of ...................., ...........

..........................................................................

                         Notary Public

My Commission expires: ..............................

 

      (Added to NRS by 2017, 691)

      NRS 449A.624  Requirements for advance directive to become operative; effect.  An advance directive for psychiatric care becomes operative when it is communicated to a physician or any other provider of health care and the principal is determined by two providers of health care, one of whom must be the attending physician or a licensed psychologist and the other of whom must be a physician, a physician assistant, a licensed psychologist, a psychiatrist or an advanced practice registered nurse who has the psychiatric training and experience prescribed by the State Board of Nursing pursuant to NRS 632.120, to be no longer able to make or communicate decisions regarding the provision of psychiatric care. If the principal is determined to be no longer able to make or communicate decisions regarding the provision of psychiatric care and subsequently the principal’s attending physician or an advance practice registered nurse who has the psychiatric training and experience prescribed by the State Board of Nursing pursuant to NRS 632.120 and has an established relationship with the principal determines that the principal has regained the ability to make or communicate decisions regarding the provision of psychiatric care, the advance directive is no longer operative. When the advance directive is operative, a physician and any other provider of health care shall act in accordance with the provisions of the advance directive and with the instructions of a person designated pursuant to NRS 449A.618, or comply with the requirements of NRS 449A.639 to transfer the care of the principal.

      (Added to NRS by 2017, 696)

      NRS 449A.627  No presumption concerning intention of person without advance directive.  NRS 449A.600 to 449A.645, inclusive, create no presumption concerning the intention of a person who has revoked or has not executed an advance directive for psychiatric care.

      (Added to NRS by 2017, 696)

      NRS 449A.630  Provider to make advance directive part of principal’s medical record.  Upon being presented with an advance directive for psychiatric care, an attending physician or other provider of health care shall make the advance directive a part of the principal’s medical record.

      (Added to NRS by 2017, 696)

      NRS 449A.633  Revocation.

      1.  A principal may revoke an advance directive for psychiatric care at any time and in any manner, as long as the principal is capable of making such a decision. The principal may exercise this right of revocation in any manner by which the principal is able to communicate an intent to revoke and by notifying the attending physician or other provider of health care of the revocation.

      2.  The attending physician or other provider of health care shall make the revocation part of the principal’s medical record.

      (Added to NRS by 2017, 696)

      NRS 449A.636  Provider to comply with advance directive; exceptions.

      1.  When acting under the authority of an advance directive for psychiatric care, an attending physician or other provider of health care shall comply with the advance directive unless:

      (a) Compliance, in the opinion of the attending physician or other provider, is not consistent with generally accepted standards of care for the provision of psychiatric care for the benefit of the principal;

      (b) Compliance is not consistent with the availability of psychiatric care requested;

      (c) Compliance is not consistent with applicable law;

      (d) The principal is admitted to a mental health facility or hospital pursuant to NRS 433A.145 to 433A.330, inclusive, and a course of treatment is required pursuant to those provisions; or

      (e) Compliance, in the opinion of the attending physician or other provider, is not consistent with appropriate psychiatric care in case of an emergency endangering the life or health of the principal or another person.

      2.  In the event that one part of the advance directive is unable to be followed because of any of the circumstances set forth in subsection 1, all other parts of the advance directive must be followed.

      (Added to NRS by 2017, 696)

      NRS 449A.639  Transfer of care of principal.  A physician or other provider of health care who is unable to comply with NRS 449A.600 to 449A.645, inclusive, shall take all reasonable steps as promptly as practicable to transfer the psychiatric care of the principal to another physician or provider of health care.

      (Added to NRS by 2017, 697)

      NRS 449A.642  Provider to inquire whether person has advance directive for psychiatric care; immunity from liability for certain actions relating to advance directive.

      1.  If two providers of health care, one of whom is a physician or a licensed psychologist and the other of whom is a physician, a physician assistant, a licensed psychologist, a psychiatrist or an advanced practice registered nurse who has the psychiatric training and experience prescribed by the State Board of Nursing pursuant to NRS 632.120, determine that a person is incapable of consenting or refusing to consent to psychiatric care, a physician or other provider of health care treating the person must make a reasonable inquiry as to whether the person has executed an advance directive for psychiatric care.

      2.  A physician or other provider of health care acting in accord with reasonable medical standards is not subject to civil or criminal liability, or discipline for unprofessional conduct, for:

      (a) Complying with a direction given or a decision made by a person that the physician or other provider believes, in good faith, has authority to act as an agent for a principal concerning decisions relating to psychiatric care;

      (b) Refusing to comply with a direction given or a decision made by a person based on a good faith belief that the person lacks the authority to act as an agency for a principal concerning decisions relating to psychiatric care;

      (c) Giving effect to an advance directive for psychiatric care that the physician or other provider assumed was valid;

      (d) Disclosing information concerning psychiatric care to another person based on a good faith belief that such disclosure was either authorized or required;

      (e) Refusing to comply with a direction given or a decision made by a person because of conflicts with the physician’s or other provider’s contractual network or payment policy restrictions;

      (f) Refusing to comply with a direction given or a decision made by a person if such direction or decision violates accepted medical or clinical standards of care;

      (g) Making a determination that causes an advance directive to become effective; or

      (h) Failing to determine that a person lacks sufficient understanding or capacity to make or communicate decisions regarding psychiatric care, thereby preventing an advance directive from becoming effective.

      3.  A physician or other provider of health care whose action pursuant to NRS 449A.600 to 449A.645, inclusive, is in accord with reasonable medical standards is not subject to civil or criminal liability, or discipline for unprofessional conduct, with respect to that action.

      4.  A person designated in an advance directive for psychiatric care pursuant to NRS 449A.618 whose decision is made in good faith pursuant to NRS 449A.600 to 449A.645, inclusive, is not subject to civil or criminal liability, or discipline for unprofessional conduct, with respect to that decision.

      (Added to NRS by 2017, 697)

      NRS 449A.645  Validity of advance directive executed in another state or instrument executed before May 26, 2017.

      1.  An advance directive for psychiatric care executed in another state in compliance with the law of that state or of this State is valid for purposes of NRS 449A.600 to 449A.645, inclusive.

      2.  An instrument executed anywhere before May 26, 2017, which clearly expresses the intent of the person executing the instrument to direct the provision of psychiatric care for the person when the person is otherwise rendered incapable of communicating with his or her attending physician, if executed in a manner which attests voluntary execution and has not been subsequently revoked, is effective under NRS 449A.600 to 449A.645, inclusive.

      3.  As used in this section, “state” includes the District of Columbia, the Commonwealth of Puerto Rico and a territory or insular possession subject to the jurisdiction of the United States.

      (Added to NRS by 2017, 698)

REGISTRY OF ADVANCE DIRECTIVES FOR HEALTH CARE

      NRS449A.700  Definitions.  As used in NRS 449A.700 to 449A.739, inclusive, unless the context otherwise requires, the words and terms defined in NRS 449A.703, 449A.706 and 449A.709 have the meanings ascribed to them in those sections.

      (Added to NRS by 2007, 2515) — (Substituted in revision for NRS 449.900)

      NRS449A.703  “Advance directive” defined.  “Advance directive” means an advance directive for health care. The term includes:

      1.  A declaration governing the withholding or withdrawal of life-sustaining treatment as set forth in NRS 449A.400 to 449A.481, inclusive;

      2.  A durable power of attorney for health care as set forth in NRS 162A.700 to 162A.865, inclusive;

      3.  An advance directive for psychiatric care as set forth in NRS 449A.600 to 449A.645, inclusive;

      4.  A do-not-resuscitate order as defined in NRS 450B.420; and

      5.  A Provider Order for Life-Sustaining Treatment form as defined in NRS 449A.542.

      (Added to NRS by 2007, 2515; A 2009, 210; 2013, 2289; 2017, 462, 698, 1767) — (Substituted in revision for NRS 449.905)

      NRS449A.706  “Registrant” defined.  “Registrant” means a person whose advance directive is registered with the Secretary of State pursuant to NRS 449A.715.

      (Added to NRS by 2007, 2515) — (Substituted in revision for NRS 449.910)

      NRS449A.709  “Registry” defined.  “Registry” means the Registry of Advance Directives for Health Care established by the Secretary of State pursuant to NRS 449A.712.

      (Added to NRS by 2007, 2515) — (Substituted in revision for NRS 449.915)

      NRS449A.712  Establishment and maintenance; information to be included in Registry.  The Secretary of State shall establish and maintain the Registry of Advance Directives for Health Care on the Internet website of the Secretary of State. The Registry must include, without limitation, in a secure portion of the website, an electronic reproduction of each advance directive. The electronic reproduction must be capable of being viewed on the website and downloaded, printed or otherwise retrieved by a person as set forth in NRS 449A.718.

      (Added to NRS by 2007, 2515) — (Substituted in revision for NRS 449.920)

      NRS449A.715  Registration of advance directive: Requirements; duties of Secretary of State.

      1.  A person who wishes to register an advance directive must submit to the Secretary of State:

      (a) An application in the form prescribed by the Secretary of State;

      (b) A copy of the advance directive; and

      (c) The fee, if any, established by the Secretary of State pursuant to NRS 449A.733.

      2.  If the person satisfies the requirements of subsection 1, the Secretary of State shall:

      (a) Make an electronic reproduction of the advance directive and post it to the Registry and, if the person consents pursuant to NRS 439.591, a health information exchange established pursuant to NRS 439.581 to 439.595, inclusive, if that health information exchange is connected to the Registry;

      (b) Assign a registration number and password to the registrant; and

      (c) Provide the registrant with a registration card that includes, without limitation, the name, registration number and password of the registrant.

      3.  The Secretary of State shall establish procedures for:

      (a) The registration of an advance directive that replaces an advance directive that is posted on the Registry;

      (b) The removal from the Registry of an advance directive that has been revoked following the revocation of the advance directive or the death of the registrant; and

      (c) The issuance of a duplicate registration card or the provision of other access to the registrant’s registration number and password if a registration card issued pursuant to this section is lost, stolen, destroyed or otherwise unavailable.

      (Added to NRS by 2007, 2515; A 2013, 2289; 2015, 1043) — (Substituted in revision for NRS 449.925)

      NRS449A.718  Access to advance directive.

      1.  Except as otherwise provided in this section, the Secretary of State shall not provide access to a registrant’s advance directive unless:

      (a) The person requesting access provides the registration number and password of the registrant;

      (b) The Secretary of State determines that providing access to the advance directive is in the best interest of the registrant;

      (c) Access to the advance directive is required pursuant to the lawful order of a court of competent jurisdiction; or

      (d) Access to the advance directive is requested by the registrant or the registrant’s personal representative.

      2.  A registrant or the personal representative of a registrant may access the registrant’s advance directive for any purpose. A provider of health care to the registrant may access the registrant’s advance directive only in connection with the provision of health care to the registrant.

      (Added to NRS by 2007, 2516) — (Substituted in revision for NRS 449.930)

      NRS449A.721  Removal of advance directive of deceased registrant.  The Secretary of State shall remove from the Registry the advance directives of deceased registrants. The State Registrar of Vital Statistics shall cooperate with the Secretary of State to identify registrants whose advance directives must be removed from the Registry. The Secretary of State shall remove from the Registry the advance directives of deceased registrants at least once every 5 years.

      (Added to NRS by 2007, 2516) — (Substituted in revision for NRS 449.935)

      NRS449A.724  Secretary of State not required to determine accuracy of contents of advance directive or validity of advance directive; effect of registration, failure to register and failure to notify Secretary of State of revocation of advance directive.

      1.  The provisions of NRS 449A.700 to 449A.739, inclusive, do not require the Secretary of State to determine whether the contents of an advance directive submitted for registration are accurate or the execution or issuance of the advance directive complies with the requirements necessary to make the advance directive valid.

      2.  The registration of an advance directive does not establish or create a presumption that the contents of the advance directive are accurate or the execution or issuance of the advance directive complies with the requirements necessary to make the advance directive valid.

      3.  Failure to register an advance directive does not affect the validity of the advance directive.

      4.  Failure to notify the Secretary of State of the revocation of a registrant’s advance directive does not affect the validity of the revocation.

      (Added to NRS by 2007, 2516) — (Substituted in revision for NRS 449.940)

      NRS449A.727  Provider of health care not required to inquire whether patient has registered advance directive or access Registry; immunity of provider of health care from criminal and civil liability.

      1.  The provisions of NRS 449A.700 to 449A.739, inclusive, do not require a provider of health care to inquire whether a patient has an advance directive registered on the Registry or to access the Registry to determine the terms of the advance directive.

      2.  A provider of health care who relies in good faith on the provisions of an advance directive retrieved from the Registry is immune from criminal and civil liability as set forth in:

      (a) NRS 449A.460, if the advance directive is a declaration governing the withholding or withdrawal of life-sustaining treatment executed pursuant to NRS 449A.400 to 449A.481, inclusive, or a durable power of attorney for health care executed pursuant to NRS 162A.700 to 162A.865, inclusive;

      (b) NRS 449A.642, if the advance directive is an advance directive for psychiatric care executed pursuant to NRS 449A.600 to 449A.645, inclusive;

      (c) NRS 449A.500 to 449A.581, inclusive, if the advance directive is a Provider Order for Life-Sustaining Treatment form; or

      (d) NRS 450B.540, if the advance directive is a do-not-resuscitate order as defined in NRS 450B.420.

      (Added to NRS by 2007, 2516; A 2009, 210; 2013, 2290; 2017, 462, 698, 1767) — (Substituted in revision for NRS 449.945)

      NRS449A.730  Immunity of Secretary of State and deputies, employees and attorneys of Secretary of State.  The Secretary of State and the deputies, employees and attorneys of the Secretary of State are not liable for any action or omission made in good faith by the Secretary of State, deputy, employee or attorney in carrying out the provisions of NRS 449A.700 to 449A.739, inclusive.

      (Added to NRS by 2007, 2516) — (Substituted in revision for NRS 449.950)

      NRS449A.733  Suspension of components of Registry and duties of Secretary of State if sufficient money not available; fees authorized; acceptance of gifts and grants.

      1.  On or before July 1 of each odd-numbered year, the Secretary of State shall make a determination of whether sufficient money is available and authorized for expenditure to fund one or more components of the programs and other duties of the Secretary of State relating to NRS 449A.700 to 449A.739, inclusive.

      2.  The Secretary of State shall temporarily suspend any components of the programs or duties of the Secretary of State for which he or she determines pursuant to subsection 1 that sufficient money is not available.

      3.  The Secretary of State may charge and collect fees and accept gifts, grants, bequests and other contributions from any source for the purpose of carrying out the provisions of NRS 449A.700 to 449A.739, inclusive.

      (Added to NRS by 2007, 2517) — (Substituted in revision for NRS 449.955)

      NRS449A.736  Deposit, accounting and use of money received; interest and income earned on money received; payment of claims.

      1.  All money received by the Secretary of State pursuant to NRS 449A.700 to 449A.739, inclusive, must be:

      (a) Deposited in the State Treasury and accounted for separately in the State General Fund; and

      (b) Used only for the purpose of carrying out the provisions of NRS 449A.700 to 449A.739, inclusive.

      2.  The Secretary of State shall administer the account. The interest and income earned on the money in the account, after deducting any applicable charges, must be credited to the account.

      3.  The money in the account does not lapse to the State General Fund at the end of any fiscal year.

      4.  Claims against the account must be paid as other claims against the State are paid.

      (Added to NRS by 2007, 2517) — (Substituted in revision for NRS 449.960)

      NRS449A.739  Regulations.  The Secretary of State may adopt regulations to carry out the provisions of NRS 449A.700 to 449A.739, inclusive.

      (Added to NRS by 2007, 2517) — (Substituted in revision for NRS 449.965)