Get Nv Do-not-resuscitate Identification Application – Adult
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the NV Do-Not-Resuscitate Identification Application – Adult online
Filling out the NV Do-Not-Resuscitate Identification Application – Adult is a crucial step for individuals who wish to ensure their medical preferences are honored in emergency situations. This guide will provide you with clear, step-by-step instructions to complete the form online efficiently.
Follow the steps to fill out your application correctly.
- Click ‘Get Form’ button to obtain the form and open it in the online editor.
- Begin by accurately filling in your personal details in the 'Patient Information' section. This includes your last name, first name, middle name, address, phone number, birthdate, and gender.
- In the 'Patient’s Statement' section, read the statement carefully. Confirm your understanding and capability to make an informed decision. Sign and date this section to indicate your consent.
- If you are appointing an agent, fill out the 'Agent’s Statement'. Provide the agent's name, address, and phone number. The agent must also sign and date this section.
- The attending physician must complete and sign the 'Attending Physician’s Statement'. Ensure that they provide their name, phone number, and NV license number as required.
- Include a check or money order for the amount of $5, payable to the Division of Public and Behavioral Health, with your completed application.
- Once all sections are completed and signed, save the form. You can then download, print, or share it as necessary.
- Lastly, mail your completed application to Emergency Medical Systems at 4150 Technology Way, Suite 101, Carson City, NV 89706.
Ensure your medical preferences are respected by completing your application online today.
For your DNR to be valid, it must include specific information such as your full name, medical condition, and signature from a qualified physician. Also, it's important to have a copy of the NV Do-Not-Resuscitate Identification Application – Adult accessible to healthcare personnel. This clarity helps ensure your preferences are respected in urgent situations.
Industry-leading security and compliance
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.