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 should be printed double-sided on 65-pound bright pink cardstock for easy recognition by EMS crews. Nevada's official guidance treats the color and paper weight as printing recommendations, not legal-validity requirements.

The form covers five sections:

• Part A: CPR or No CPR (full resuscitation vs. do not attempt)
• Part B: Medical interventions — full treatment, limited additional interventions (IV fluids and cardiac monitoring but no intubation), or comfort-focused treatment
• Part C: Artificially administered nutrition and fluids
• Part D: Capacity determination
• Part E: Validating signatures, including the provider and the patient or the patient's representative or surrogate

A POLST should be completed after an in-depth clinical conversation. A physician, APRN, or physician assistant must review and sign it, and the patient or the patient's representative or surrogate must also sign it; other knowledgeable medical personnel may help complete Side 1.

Who Qualifies for a POLST

The POLST is designed for people with a life-limiting medical condition or advanced frailty, rather than for routine planning by healthy adults. Nevada requires a physician, APRN, or physician assistant to explain the form if the provider diagnoses a terminal condition, determines the patient's life expectancy is less than five years, or the patient requests it.

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.400 to 450B.590; NRS 450B.420 defines the do-not-resuscitate order. 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 certification from your attending physician or APRN that you have a terminal condition, 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. Can be 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, APRN, or physician assistant. Printed on the recommended pink cardstock. Honored by paramedics and ER staff.

Out-of-Hospital DNR → Narrowest order. Addresses only the CPR question. State-issued card or medallion. One state-issued option 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 CPR en route. Having a POLST without an advance directive means emergency orders are covered, but a POLST does not by itself appoint an agent for 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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