Nevada Advance Directive

Information you will need

• Agent Area Code
• Agent Phone
• Principal Initial
• Conditions and Limitations
• Termination Day and Month
• Termination Year
• All Treatment Provided
• Terminal Condition
• Coma
• Treatment Causing Burdens
• Other Wishes
• Agent Extension
• Alternate Agent Area Code
• Alternate Agent Phone
• Principal Signing Day and Month
• Principal Signing Address
• Principal Area Code
• Principal Phone
• Principal Extension
• Principal SSN
• Notary Only: Month
• Notary Only: Year
• Notary Only: Name
• Notary Only: Day

…and 77 more fields in the PDF.

Completed by the principal and the provider and the employee.

The form includes 7 signature lines, a notary acknowledgment, a witness section.