Nevada POLST Form: How It Works and Why Your Advance Directive Is Not Enough

You signed an advance directive. You registered it with the Lockbox. You carry the wallet card. Then paramedics arrive at your home after a cardiac event — and they start CPR anyway.

This is not a failure of the system. It is how Nevada law works. An advance directive is a legal planning document. Paramedics and EMTs are legally required to attempt resuscitation unless they see a signed medical order — either a POLST or an Out-of-Hospital DNR.

What a Nevada POLST Actually Is

A Provider Order for Life-Sustaining Treatment (POLST) is a clinical medical order governed by NRS 449A.542. Unlike an advance directive, which records your wishes, a POLST translates those wishes into binding instructions that emergency responders must follow.

The form must be printed double-sided on 65-pound bright pink cardstock — not regular paper. This specific color and weight ensure immediate recognition by EMS crews. A POLST printed on white paper may not be honored at the scene.

The form covers three sections:

• Part A: CPR or No CPR (full resuscitation vs. do not attempt)
• Part B: Level of medical intervention — full treatment, selective treatment (IV fluids and cardiac monitoring but no intubation), or comfort-only measures
• Part C: Surrogate authorization and physician signature

A POLST must be completed during an in-depth clinical conversation and signed by a physician, APRN, or physician assistant. You cannot fill it out yourself.

Who Qualifies for a POLST

The POLST is not for healthy adults doing routine planning. It is designed for people diagnosed with a terminal illness or those who are very frail and elderly. Your physician initiates the conversation, typically when your prognosis is measured in months rather than years.

If you are a healthy 55-year-old completing end-of-life documents for the first time, the advance directive is your tool. The POLST comes later, when clinical circumstances warrant it.

The Out-of-Hospital DNR: A Narrower Alternative

Nevada also offers an Out-of-Hospital Do Not Resuscitate order under NRS 450B.420. This is more limited than a POLST — it addresses only CPR (whether paramedics attempt resuscitation if your heart stops), not the broader range of interventions covered by POLST Parts A through C.

To obtain one, you must submit an application to the Division of Public and Behavioral Health (or the Southern Nevada Health District if you live in Clark County). The application requires a physician certification that you are terminally ill, plus a $5 state fee. Once approved, you receive an official card, bracelet, or medallion that EMS crews are trained to recognize.

How the Three Documents Work Together

Think of it as a hierarchy:

Advance Directive → Legal document. Names your healthcare agent. Records your treatment wishes. Filed with the Nevada Lockbox. Active indefinitely, effective whenever you cannot speak for yourself.

POLST → Medical order. Translates your wishes into actionable clinical instructions. Signed by your physician. Printed on pink cardstock. Honored by paramedics and ER staff.

Out-of-Hospital DNR → Narrowest order. Addresses only the CPR question. State-issued card or medallion. Required if you want EMS to withhold resuscitation at home.

Having an advance directive without a POLST means your agent can make decisions at the hospital — but paramedics will still attempt full resuscitation en route. Having a POLST without an advance directive means emergency orders are covered, but nobody has legal authority to make broader medical decisions if your condition changes in ways the POLST does not address.

Coordinating Your Documents

Start with the advance directive. Designate your agent, specify your treatment preferences, and register with the Lockbox. When your health status warrants it, ask your physician about executing a POLST that aligns with the wishes you already documented.

The Nevada Advance Directive & Living Will Kit includes a POLST coordination reference that explains exactly when and how to ask your doctor to convert your directive into a binding medical order.

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