Nevada Do Not Resuscitate (DNR) Form

Nevada Do Not Resuscitate (DNR) Form

A Nevada do not resuscitate form is used to ensure that a patient does not receive CPR if they cease to breathe or have a pulse. This document, known as a Provider Order for Life-Sustaining Treatment (POLST) provides health care staff with a patient’s instructions regarding artificial feeding, life-support treatment, and the extent of medical intervention in a health care emergency.

Last updated June 16th, 2025

A Nevada do not resuscitate form is used to ensure that a patient does not receive CPR if they cease to breathe or have a pulse. This document, known as a Provider Order for Life-Sustaining Treatment (POLST) provides health care staff with a patient’s instructions regarding artificial feeding, life-support treatment, and the extent of medical intervention in a health care emergency.

  1. Home »
  2. Do Not Resuscitate (DNR) Forms »
  3. Nevada
As per DPBH guidelines, it is recommended to print this POLST form on bright pink card stock.[1]

Signing Requirements

A POLST form must be signed by the patient (or the representative) and an attending physicianadvanced practice registered nurse, or physician’s assistant.[2]

Do Not Resuscitate (Preview)

Do-Not-Resuscitate Identification Application – Allows an individual with a valid DNR order to apply for a DNR identification.