Nevada Advance Directive Registry and Living Will Lockbox: Registration Guide

What the Living Will Lockbox Does

Nevada's Secretary of State maintains the Living Will Lockbox — a free, statewide electronic registry where residents can register their advance healthcare directives, durable powers of attorney for healthcare decisions, and do-not-resuscitate orders. Once registered, any authorized healthcare provider in Nevada can access the documents instantly during a medical emergency.

The practical value is straightforward: when your parent arrives at an emergency room unconscious or unable to communicate, the treating physicians can pull up their registered directive electronically instead of trying to locate a paper copy in the middle of a crisis. The registration creates a reliable backup that follows the patient across every hospital and care facility in the state.

Registration is free. There is no state fee.

How to Register

The registration process requires submitting documents to the Nevada Secretary of State's office:

Step 1: Complete the Registration Agreement. Download the Registration Agreement form from the Secretary of State's website at nvsos.gov. Complete and sign it according to the form's instructions; do not assume that both the principal (your parent) and the designated healthcare agent must sign.

Step 2: Prepare the documents. Make legible copies of all advance directives to be registered:

• Durable Power of Attorney for Healthcare Decisions (NRS 162A.860 or NRS 162A.870 for adults with dementia)
• Declaration Governing the Withholding or Withdrawal of Life-Sustaining Treatment (living will)
• POLST form, if applicable
• Do-Not-Resuscitate Order, if applicable

Step 3: Submit by mail or fax. Send the signed Registration Agreement and copies of all documents to the Secretary of State's office. The mailing address and fax number are on the Registration Agreement form.

Step 4: Receive the wallet card. After processing (approximately 30 to 45 days), the Secretary of State issues a wallet-sized card with a unique registration ID and password. Your parent should carry this card. You, as the healthcare agent, should also have the ID and password.

Step 5: Access verification. Once registered, authorized healthcare providers can access the documents through the Lockbox system using the registration ID. You and your parent can also access and download the documents at any time to verify they are current.

Updating or Revoking Registered Documents

If your parent updates their healthcare directive — changing the designated agent, modifying end-of-life preferences, or adding dementia-specific instructions under NRS 162A.870 — the registry must be updated to reflect the current documents.

Submit an Authorization to Change Form with the updated documents. Follow the current Lockbox instructions about replacing the old registered copy. There is no fee for updates.

To change registered directives, submit an Authorization to Change Form with the updated documents. To withdraw them from the registry, submit the written withdrawal request required by the Lockbox instructions. Confirm with the registry that the active documents have been updated or withdrawn.

Do Not Resuscitate Orders in Nevada

A Do-Not-Resuscitate (DNR) order in Nevada is a physician's order, not a patient document. The physician writes the order based on the patient's expressed wishes (or the healthcare agent's decision when the patient lacks capacity). The DNR instructs emergency medical personnel and healthcare providers not to perform CPR if the patient's heart stops or they stop breathing.

Key points about Nevada DNR orders:

The DNR requires a medical order. A physician or advanced practice registered nurse issues the written DNR order; a patient or agent cannot create one independently.

Emergency personnel will perform CPR by default. If EMS arrives and there is no visible DNR order (or the Lockbox registration is not accessed), they will begin resuscitation. Having the DNR registered in the Lockbox and keeping a physical copy with the patient at home improves the chance that the order is honored during a 911 response.

A DNR does not refuse all treatment. It specifically addresses cardiopulmonary resuscitation. A patient with a DNR can still receive pain management, antibiotics, IV fluids, and other medical interventions.

Revocation follows Nevada's DNR rules. Under NRS 450B.530, an adult qualified patient can revoke the DNR identification by removing or destroying it, or by indicating to the physician or advanced practice registered nurse that they wish to revoke it. NRS 450B.520 separately allows an authorized healthcare agent to sign the DNR application in specified circumstances; it does not make an agent's instruction to any provider a universal revocation method. Ask the issuing clinician and update the Lockbox record.

How the Lockbox Relates to POLST Forms

A POLST (Provider Order for Life-Sustaining Treatment) form is broader than a DNR. It covers CPR preferences, mechanical ventilation, feeding tubes, antibiotics, and hospitalization preferences. Like a DNR, it is a physician's order rather than a patient directive.

The POLST is typically used for people with serious chronic illnesses, advanced age, or progressive conditions like dementia. It translates the patient's general wishes (expressed in their advance directive) into specific medical orders that providers follow across care settings — hospital, skilled nursing facility, assisted living, and home.

A POLST can be registered in the Living Will Lockbox alongside the advance directive and healthcare POA, creating a single access point for all of the patient's end-of-life care preferences.

Getting the Foundation Right

The Living Will Lockbox is the last step in a sequence that starts with executing the healthcare power of attorney itself. The Nevada Power of Attorney & Guardianship Kit includes the NRS 162A.860 healthcare POA form, the NRS 162A.870 dementia-specific variant, the Lockbox Registration Agreement walkthrough, and a checklist for coordinating the DNR and POLST discussions with your parent's physician.

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