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Nevada Dementia Health Care Directive Guide
The Nevada dementia-specific durable power of attorney for health care decisions allows an adult with any form of dementia to designate an agent and an alternate agent for health care decisions. The form provided on this page is a fillable copy hosted by Nevada Caregivers and based on the statutory form set out in NRS 162A.870. It also contains an optional End-of-Life Decisions Addendum.
The principal must personally sign the document and choose one of two execution methods: the principal’s signature must be acknowledged before a notary public or witnessed by two qualified adults. A person using the notary route does not also need two witnesses. If the optional addendum is completed, it has its own signature and execution section.
Lake Mead Mobile Notary can perform the requested acknowledgment for a prepared document. We do not select the form, choose the agent, complete treatment or end-of-life choices, diagnose capacity, decide when an agent may act, or create authority after the principal can no longer execute the document.
About This Form
Nevada law contains a separate health care power-of-attorney form for an adult with any form of dementia. The linked nine-page PDF is a fillable copy supplied by Nevada Caregivers rather than a PDF issued directly by the Nevada Legislature.
NRS 162A.870 provides the dementia-specific form and a separate optional End-of-Life Decisions Addendum. NRS 162A.815, which is also mentioned inside the form, concerns good-faith acceptance and reliance and is not the section that creates the form.
Review the current statutory language before completing the document, especially if the PDF has been saved for a long time. External forms and statutory wording can change.
Nevada separately provides a general health care power-of-attorney form and a form for an adult with an intellectual disability. Confirm that the dementia-specific form is the document the principal and the principal’s adviser intend to use.
The document addresses health care decisions and access to health information. It does not authorize banking, property, benefits, contracts, taxes, or other financial transactions.
Review the current NRS 162A.870 statutory form and the Nevada Caregivers document page.
Execution Options
The document is not valid for making health care decisions unless the principal uses one of the two printed execution routes. The routes are alternatives, not cumulative requirements.
The principal personally appears, establishes identity, and acknowledges executing the document. Because the printed certificate is an acknowledgment, the principal may sign during the appointment or acknowledge a signature made earlier unless the principal’s attorney or other written instructions require in-person signing.
The form’s witness route requires two adults who personally know the principal and are present when the principal signs or acknowledges the signature. The printed form excludes the agent, health care providers, specified provider or facility personnel, and requires at least one witness to make an additional disinterested-witness declaration.
The PDF contains an agent signature and acceptance section, but the printed notarial certificate identifies the principal. The proposed agent does not need to attend solely for the principal’s acknowledgment unless an attorney, provider, or other instruction requires coordinated signing.
When the End-of-Life Decisions Addendum is completed, the principal must date and sign that addendum and use its separate notary or witness section. Do not assume the certificate for the main POA automatically covers a separate addendum signature.
Capacity and Free Will
A dementia diagnosis does not automatically establish that a person can or cannot complete a notarial act. The decision depends on the principal’s participation at the time of the requested acknowledgment.
The principal must answer the notary’s questions directly and communicate enough to establish identity, awareness of the document, and a voluntary acknowledgment. Family members and the proposed agent may not answer in the principal’s place.
Nevada law permits a notarial officer to refuse when the officer is not satisfied that the signer is competent or has capacity to execute the record. For this purpose, competence concerns the signer’s apparent ability to understand the nature and consequences of the notarial act.
The principal must act without coercion, fraud, pressure, or coaching. A family deadline, facility request, hospital discharge, or fear of losing authority does not allow another person to direct the principal’s answers.
Lake Mead Mobile Notary requires the principal to physically sign this health care power of attorney. Contact a Nevada attorney before booking when the principal cannot physically sign instead of assuming another person may execute the document.
The notary does not diagnose dementia, certify legal capacity, or rely only on a family member’s description of a lucid interval. The notary makes an independent decision based on the actual interaction during the appointment.
The notary may ask relatives, caregivers, facility employees, or the proposed agent to step away so the principal can communicate without coaching or pressure.
Agent Authority
The principal chooses the agent and any alternate agent. A spouse, adult child, caregiver, or friend does not become the principal’s health care agent merely because of the relationship or caregiving role.
The document describes the agent’s role in communicating with providers, helping with treatment decisions, signing necessary health care paperwork, and accessing medical records within the authority granted by the principal.
The agent acceptance section lists categories of treatment the agent may not authorize and requires the agent to follow the principal’s stated desires or, when those desires are unknown, act in the principal’s best interest. Obtain legal and medical guidance about those limits.
Nevada law generally treats a health care power of attorney as effective when executed unless the principal provides for a future date or incapacity. If the document is written to begin upon incapacity, the statutory determination process applies.
The agent does not gain authority over bank accounts, real property, insurance benefits, taxes, contracts, or other financial matters merely by being named in this health care form.
A power of attorney is created by the principal. Guardianship is a court process. The notary cannot determine whether an existing guardianship limits, suspends, or affects the agent’s authority.
The POA designates an agent and records instructions, but it is not itself an emergency medical order. POLST and DNR questions belong with the principal’s qualified health care professional.
Appointment Preparation
The form should be selected and substantially completed before the mobile notary arrives. The notary performs the acknowledgment but does not prepare the health care directive.
Bring every page of the dementia-specific POA. Confirm that the form is the intended document and that the principal’s name, address, agent, alternate agent, and other requested information are complete.
The principal and the principal’s legal or health care adviser must resolve treatment preferences, limits, and any optional End-of-Life Decisions Addendum choices. The notary cannot explain which options to select.
The principal must present an original, current physical government-issued identification document acceptable to the notary. Lake Mead Mobile Notary does not accept a photograph, screenshot, scan, or photocopy of identification.
Tell the notary in advance when the principal uses hearing aids, writing, a communication device, an interpreter, or another accommodation. The communication must remain direct and reliable.
Keep the appropriate professional available for questions about form selection, treatment instructions, agent authority, guardianship, the effect of a diagnosis, or the legal consequences of the document.
Confirm whether the agent has completed the acceptance section and whether the attorney or receiving provider requires the agent to sign at a particular time. The principal’s notary appointment does not automatically resolve a missing agent signature.
Hospital, Memory Care, and Assisted Living Visits
Ask about visiting hours, check-in, unit access, parking, isolation precautions, infection-control rules, and whether the principal will be available at the scheduled time.
Find the principal’s original, current identification before the appointment. A family member’s ID, facility wristband, chart label, or phone image of an ID does not satisfy Lake Mead Mobile Notary’s policy.
Coordinate around medication, procedures, meals, therapy, fatigue, sleep patterns, and clinical care. The principal must participate meaningfully at the time of the acknowledgment.
Family may coordinate logistics and provide the prepared form, but may not answer for the principal, rehearse answers, direct the principal’s decision, or pressure the principal to sign.
A physician, nurse, social worker, facility administrator, or relative may provide context but cannot require the notary to proceed. The notary may decline based on identity, capacity, understanding, voluntariness, or signing concerns.
Booking Guidance
Book only after the correct document has been selected, the principal’s choices are complete, and the principal can personally participate in the requested acknowledgment.
Select this for the prepared dementia-specific health care POA when the principal is ready to appear, communicate directly, acknowledge the document, physically sign, and present acceptable original identification.
Select the broader estate-planning option when the appointment includes a completed living will, trust, End-of-Life Decisions Addendum, or a larger prepared directive set in addition to the health care POA.
Contact (702) 748-7444 before booking when access, identification, communication, medication, alertness, physical signing ability, or family pressure may affect the appointment.
Do not schedule yet when the family is still selecting the form, agent, alternate, treatment instructions, addendum choices, or legal strategy, or when the principal cannot communicate a voluntary decision or physically sign.
After the Appointment
The form instructs the principal to retain an executed copy and provide one to the agent. Confirm that the agent knows where the original and copies are stored.
Make the POA and any completed addendum available to physicians, hospitals, facilities, and other providers as appropriate. Each receiving organization determines its own review process.
Do not place the only executed copy somewhere the agent or health care team cannot reach during an emergency. Keep a record of who received copies.
The Nevada Secretary of State maintains an Advance Directive Registry through the Nevada Lockbox. Review the current filing instructions before submitting a copy.
Learn about the Nevada Lockbox Advance Directive Registry.
Common Questions
Not necessarily. The principal may acknowledge the signature before a notary public or use the form’s two-qualified-witness procedure. A person using the notary route does not also need two witnesses.
The language is based on the statutory form in NRS 162A.870, but the fillable PDF is hosted by Nevada Caregivers rather than issued as a PDF by the Nevada Legislature. Compare it with the current statute before use.
A diagnosis alone does not decide the appointment. The principal must personally communicate, understand the nature and consequences of the notarial act, act knowingly and voluntarily, establish identity, and physically sign under Lake Mead Mobile Notary’s service policy.
No. The principal creates and signs this power of attorney. A family member, caregiver, or proposed agent cannot create the appointment by signing in the principal’s place.
The printed certificate is an acknowledgment, not a jurat. The principal may sign during the appointment or personally acknowledge a prior signature. Lake Mead Mobile Notary may ask the principal to sign during the meeting as an operational safeguard.
Not solely for the principal’s acknowledgment. The form contains a separate agent acceptance section, but the printed notarial certificate identifies the principal. Confirm any coordinated signing requirement with the attorney or receiving provider.
The form describes the addendum as optional. When the principal chooses to complete it, the addendum must be dated, signed, and separately acknowledged before a notary or executed with its qualified witnesses.
Lake Mead Mobile Notary will not complete this appointment when the principal cannot communicate a knowing and voluntary decision or cannot physically sign. Consult a Nevada elder-law attorney about guardianship or another lawful procedure.
No. This is a health care power of attorney. Financial, property, benefits, banking, tax, and contract authority require a different instrument or other lawful authority.
Notarization does not guarantee acceptance, legal sufficiency, or implementation. The receiving provider or institution determines how it reviews the directive and whether additional records or instructions are required.
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