As used in this chapter, unless the
context otherwise requires, the words and terms defined in NRS 449.0015
to 449.0195 , inclusive, have the meanings ascribed to
them in those sections.
(Added to NRS by 1973, 1278; A 1975, 366, 897; 1977, 641; 1979,
160, 1113; 1983, 1657; 1985, 1736; 1989, 304, 1034, 1037; 1993, 2556;
1995, 1600; 1999, 248 , 970 ; 2001, 1341 , 2518 ; 2005, 485 , 532 , 1379 , 1517 , 2165 , 2350 )
“Agency to provide nursing in the home” means any person or governmental
organization which provides in the home, through its employees or by
contractual arrangement with other persons, skilled nursing and
assistance and training in health and housekeeping skills. The term does
not include a provider of supported living arrangement services during
any period in which the provider of supported living arrangement services
is engaged in providing supported living arrangement services.
(Added to NRS by 1979, 160; A 1985, 1737; 2005, 1379 )
1. “Agency to provide personal care services in the home” means
any person, other than a natural person, which provides in the home,
through its employees or by contractual arrangement with other persons,
nonmedical services related to personal care to elderly persons or
persons with mental or physical disabilities to assist those persons with
activities of daily living, including, without limitation:
(a) The elimination of wastes from the body;
(b) Dressing and undressing;
(c) Bathing;
(d) Grooming;
(e) The preparation and eating of meals;
(f) Laundry;
(g) Shopping;
(h) Cleaning;
(i) Transportation; and
(j) Any other minor needs related to the maintenance of personal
hygiene.
2. The term does not include:
(a) An independent contractor who provides nonmedical services
specified by subsection 1 without the assistance of employees; or
(b) A microboard, as defined by regulations adopted by the Board.
(Added to NRS by 2005, 2164 )
“Board” means the State Board of
Health.
(Added to NRS by 1985, 1735)
“Community triage
center” means a facility that provides on a 24-hour basis medical
assessments of and short-term monitoring services for mentally ill
persons and abusers of alcohol or drugs in a manner which does not
require that the assessments and services be provided in a licensed
hospital.
(Added to NRS by 2005, 532 )
“Facility for
hospice care” means a facility which is operated to provide hospice care.
(Added to NRS by 1999, 248 )
“Facility
for intermediate care” means an establishment operated and maintained to
provide 24-hour personal and medical supervision, for a person who does
not have illness, disease, injury or other condition that would require
the degree of care and treatment which a hospital or facility for skilled
nursing is designed to provide.
(Added to NRS by 1973, 1279; A 1985, 1737; 1991, 1974)
“Facility for modified medical detoxification” means a facility
that provides 24-hour medical monitoring of treatment and detoxification
in a manner which does not require that the service be provided in a
licensed hospital.
(Added to NRS by 1999, 969 )
“Facility for refractive surgery” means a freestanding facility that
provides limited medical services for the evaluation of patients with
refractive errors of the eye and the surgical treatment of those patients.
(Added to NRS by 2001, 1339 ; A 2005, 2693 )
1. “Facility for skilled nursing” means an establishment which
provides continuous skilled nursing and related care as prescribed by a
physician to a patient in the facility who is not in an acute episode of
illness and whose primary need is the availability of such care on a
continuous basis.
2. “Facility for skilled nursing” does not include a facility
which meets the requirements of a general or any other special hospital.
(Added to NRS by 1973, 1279; A 1985, 1738)—(Substituted in revision
for NRS 449.018)
“Facility for the care of adults during the day” means an
establishment operated and maintained to provide care during the day on a
temporary or permanent basis for aged or infirm persons. The term does
not include a halfway house for recovering alcohol and drug abusers.
(Added to NRS by 1983, 1657; A 1985, 1736; 2001, 2518 )
“Facility for
the dependent” includes:
1. A facility for the treatment of abuse of alcohol or drugs;
2. A halfway house for recovering alcohol and drug abusers;
3. A facility for the care of adults during the day;
4. A residential facility for groups;
5. An agency to provide personal care services in the home; and
6. A facility for transitional living for released offenders.
(Added to NRS by 1985, 1735; A 2001, 2518 ; 2005, 2165 , 2350 )
[Effective through June 30, 2007.] “Facility for the
treatment of abuse of alcohol or drugs” means any public or private
establishment which provides residential treatment, including mental and
physical restoration, of abusers of alcohol or drugs and which is
certified by the Health Division pursuant to subsection 4 of NRS 458.025
. It does not include a medical facility
or services offered by volunteers or voluntary organizations.
(Added to NRS by 1975, 366; A 1985, 1736; 1993, 1624; 1999, 1871
; 2001, 417 )
[Effective July 1, 2007.] “Facility for the treatment of
abuse of alcohol or drugs” means any public or private establishment
which provides residential treatment, including mental and physical
restoration, of abusers of alcohol or drugs and which is certified by the
Division of Mental Health and Developmental Services of the Department of
Health and Human Services pursuant to subsection 4 of NRS 458.025 . It does not include a medical facility or
services offered by volunteers or voluntary organizations.
(Added to NRS by 1975, 366; A 1985, 1736; 1993, 1624; 1999, 1871
; 2001, 417 ; 2005, 22nd Special Session, 56 , effective July 1, 2007)
“Facility for the treatment of irreversible renal
disease” means a facility that is not part of a hospital and which
provides peritoneal dialysis or hemodialysis or trains a person with a
permanent irreversible renal impairment to perform dialysis for himself.
(Added to NRS by 1985, 1735)
1. “Facility for transitional living for released offenders” means
a residence that provides housing and a living environment for persons
who have been released from prison and who require assistance with
reintegration into the community, other than such a residence that is
operated or maintained by a state or local government or an agency
thereof. The term does not include a halfway house for recovering alcohol
and drug abusers or a facility for the treatment of abuse of alcohol or
drugs.
2. As used in this section, “person who has been released from
prison” means:
(a) A parolee.
(b) A person who is participating in:
(1) A judicial program pursuant to NRS 209.4886 or 213.625 ;
or
(2) A correctional program pursuant to NRS 209.4888 or 213.632 .
(c) A person who is supervised by the Division of Parole and
Probation of the Department of Public Safety through residential
confinement pursuant to NRS 213.371 to
213.410 , inclusive.
(d) A person who has been released from prison by expiration of his
term of sentence.
(Added to NRS by 2005, 2349 )
“Halfway house for recovering alcohol and drug
abusers” means a residence that provides housing and a living environment
for recovering alcohol and drug abusers and is operated to facilitate
their reintegration into the community, but does not provide any
treatment for alcohol or drug abuse. The term does not include a facility
for transitional living for released offenders.
(Added to NRS by 2001, 2518 ; A 2005, 2350 )
“Health Division” means
the Health Division of the Department of Health and Human Services.
(Added to NRS by 1973, 1279; A 1973, 1406)
“Home for individual residential care” means a home in which a natural
person furnishes food, shelter, assistance and limited supervision, for
compensation, to not more than two persons who are aged, infirm, mentally
retarded or handicapped, unless the persons receiving those services are
related within the third degree of consanguinity or affinity to the
person providing those services. The term does not include:
1. A halfway house for recovering alcohol and drug abusers; or
2. A home in which supported living arrangement services are
provided by a provider of supported living arrangement services during
any period in which the provider of supported living arrangement services
is engaged in providing supported living arrangement services.
(Added to NRS by 1993, 2556; A 2001, 2518 ; 2005, 1380 )
1. “Hospice care” means a centrally administered program of
palliative services and supportive services provided by an
interdisciplinary team directed by a physician. The program includes the
provision of physical, psychological, custodial and spiritual care for
persons who are terminally ill and their families. The care may be
provided in the home, at a residential facility or at a medical facility
at any time of the day or night. The term includes the supportive care
and services provided to the family after the patient dies.
2. As used in this section:
(a) “Family” includes the immediate family, the person who
primarily cared for the patient and other persons with significant
personal ties to the patient, whether or not related by blood.
(b) “Interdisciplinary team” means a group of persons who work
collectively to meet the special needs of terminally ill patients and
their families and includes such persons as a physician, registered
nurse, social worker, clergyman and trained volunteer.
(Added to NRS by 1979, 1112; A 1985, 1737; 1989, 1035; 2005, 485
)
“Hospital” means an establishment
for the diagnosis, care and treatment of human illness, including care
available 24 hours each day from persons licensed to practice
professional nursing who are under the direction of a physician, services
of a medical laboratory and medical, radiological, dietary and
pharmaceutical services.
(Added to NRS by 1973, 1279; A 1985, 1737)
“Independent center for emergency medical care” means a
facility, structurally separate and distinct from a hospital, which
provides limited services for the treatment of a medical emergency.
(Added to NRS by 1985, 1735)
“Licensed
practical nurse” has the meaning ascribed to it in NRS 632.016 .
(Added to NRS by 2005, 1517 )
“Medical facility”
includes:
1. A surgical center for ambulatory patients;
2. An obstetric center;
3. An independent center for emergency medical care;
4. An agency to provide nursing in the home;
5. A facility for intermediate care;
6. A facility for skilled nursing;
7. A facility for hospice care;
8. A hospital;
9. A psychiatric hospital;
10. A facility for the treatment of irreversible renal disease;
11. A rural clinic;
12. A nursing pool;
13. A facility for modified medical detoxification;
14. A facility for refractive surgery;
15. A mobile unit; and
16. A community triage center.
(Added to NRS by 1973, 1279; A 1975, 366; 1979, 161, 887, 1113;
1983, 1657; 1985, 1736; 1989, 304, 1035, 1037; 1999, 248 , 970 ; 2001, 1341 ; 2005, 532 , 2693 )
1. Except as otherwise provided in subsection 2, “mobile unit”
means a motor vehicle that is specially designed, constructed and
equipped to provide any of the medical services provided by a medical
facility described in subsections 1 to 13, inclusive, of NRS 449.0151
.
2. “Mobile unit” does not include:
(a) A motor vehicle that is operated by a medical facility
described in subsections 1 to 13, inclusive, of NRS 449.0151 which is accredited by the Joint Commission
on Accreditation of Healthcare Organizations or the American Osteopathic
Association;
(b) A motor vehicle that is operated by a health center that is
funded under section 330 of the Public Health Service Act, 42 U.S.C. §
254b, as amended; or
(c) A vehicle operated under the authority of a permit issued
pursuant to chapter 450B of NRS.
(Added to NRS by 2001, 1339 ; A 2003, 421 )
“Nursing assistant” has
the meaning ascribed to it in NRS 632.0166 .
(Added to NRS by 2005, 1517 )
“Nursing pool” means a
person or agency which provides for compensation, through its employees
or by contractual arrangement with other persons, nursing services to any
natural person, medical facility or facility for the dependent. The term
does not include:
1. An independent contractor who provides such services without
the assistance of employees;
2. A nursing pool based in a medical facility or facility for the
dependent; or
3. A provider of supported living arrangement services during any
period in which the provider of supported living arrangement services is
engaged in providing supported living arrangement services.
(Added to NRS by 1989, 303; A 2005, 1380 )
“Obstetric center” means
a facility that is not part of a hospital and provides services for
normal, uncomplicated births.
(Added to NRS by 1985, 1735)
“Palliative services”
means services and treatments directed toward the control of pain and
symptoms which provide the greatest degree of relief for the longest
period while minimizing any adverse effects of the services and
treatments, including, without limitation, any side effects of any
medications given or administered.
(Added to NRS by 2005, 485 )
“Provider of
health care” has the meaning ascribed to it in NRS 629.031 .
(Added to NRS by 1995, 1600)
“Provider of supported living arrangement services” means a
natural person who or a partnership, firm, corporation, association,
state or local government or agency thereof that has been issued a
certificate pursuant to NRS 435.3305
to 435.339 , inclusive, and the
regulations adopted pursuant to NRS 435.3305 to 435.339 ,
inclusive.
(Added to NRS by 2005, 1379 )
“Psychiatric
hospital” means a hospital for the diagnosis, care and treatment of
mental illness which provides 24-hour residential care.
(Added to NRS by 1985, 1735)
“Registered nurse” has
the meaning ascribed to it in NRS 632.019 .
(Added to NRS by 2005, 1517 )
1. Except as otherwise provided in subsection 2, “residential
facility for groups” means an establishment that furnishes food, shelter,
assistance and limited supervision to an aged, infirm, mentally retarded
or handicapped person. The term includes, without limitation, an assisted
living facility.
2. The term does not include:
(a) An establishment which provides care only during the day;
(b) A natural person who provides care for no more than two persons
in his own home;
(c) A natural person who provides care for one or more persons
related to him within the third degree of consanguinity or affinity;
(d) A halfway house for recovering alcohol and drug abusers; or
(e) A facility funded by a division or program of the Department of
Health and Human Services.
(Added to NRS by 1973, 1278; A 1979, 212; 1983, 1657; 1985, 930,
1736; 1991, 1974; 1993, 1213; 1999, 114 , 125 ; 2001, 57 , 546 , 2519 , 2522 )
“Rural clinic” means a
facility located in an area that is not designated as an urban area by
the Bureau of the Census, where medical services are provided by a
physician assistant or an advanced practitioner of nursing under the
supervision of a licensed physician.
(Added to NRS by 1985, 1735; A 2001, 782 )
“Rural hospital” means a
hospital with 85 or fewer beds which is:
1. The sole institutional provider of health care located within a
county whose population is less than 100,000;
2. The sole institutional provider of health care located within a
city whose population is less than 25,000; or
3. Maintained and governed pursuant to NRS 450.550 to 450.750 ,
inclusive.
(Added to NRS by 1995, 1600; A 2001, 1992 )
“Supported living arrangement services” has the meaning ascribed to it
in NRS 435.3315 .
(Added to NRS by 2005, 1379 )
“Surgical center for ambulatory patients” means a facility with limited
medical services available for diagnosis or treatment of patients by
surgery where the patients’ recovery, in the opinion of the surgeon, will
not require care as a patient in the facility for more than 24 hours.
(Added to NRS by 1975, 366; A 1985, 1736; 1993, 207)
“Terminally ill” means a
medical diagnosis made by a physician that a person has an anticipated
life expectancy of not more than 12 months.
(Added to NRS by 2005, 485 )
1. A hospital which provides only one or two of the following
categories of service:
(a) Medical;
(b) Surgical;
(c) Obstetrical; or
(d) Psychiatric,
Ê shall be designated a medical hospital, surgical hospital, obstetrical
hospital or psychiatric hospital or combined-categories hospital, as the
case may be.
2. When a hospital offers services in medical, surgical and
obstetrical categories, as a minimum, it shall be designated a general
hospital.
(Added to NRS by 1971, 933; A 1973, 1280)
The name, sign, listing or other designation of a medical
facility or facility for the dependent must not contain any terms
misleading to the public with regard to the services offered.
(Added to NRS by 1973, 1279; A 1975, 367; 1985, 1738)
1. No person, state or local government or agency thereof may
operate or maintain in this State any medical facility or facility for
the dependent without first obtaining a license therefor as provided in
NRS 449.001 to 449.240 , inclusive.
2. Unless licensed as a facility for hospice care, a person, state
or local government or agency thereof shall not operate a program of
hospice care without first obtaining a license for the program from the
Board.
[Part 1:336:1951]—(NRS A 1971, 934; 1973, 1281; 1985, 1738; 1989,
1035; 1997, 444, 1484; 1999, 249 , 3608 )
1. Except as otherwise provided in subsection 5, a person must
obtain a license from the Board to operate a business that provides
referrals to residential facilities for groups.
2. The Board shall adopt:
(a) Standards for the licensing of businesses that provide
referrals to residential facilities for groups;
(b) Standards relating to the fees charged by such businesses;
(c) Regulations governing the licensing of such businesses; and
(d) Regulations establishing requirements for training the
employees of such businesses.
3. A licensed nurse, social worker, physician or hospital, or a
provider of geriatric care who is licensed as a nurse or social worker,
may provide referrals to residential facilities for groups through a
business that is licensed pursuant to this section. The Board may, by
regulation, authorize a public guardian or any other person it determines
appropriate to provide referrals to residential facilities for groups
through a business that is licensed pursuant to this section.
4. A business that is licensed pursuant to this section or an
employee of such a business shall not:
(a) Refer a person to a residential facility for groups that is not
licensed.
(b) Refer a person to a residential facility for groups that is
owned by the same person who owns the business.
Ê A person who violates the provisions of this subsection is liable for a
civil penalty to be recovered by the Attorney General in the name of the
State Board of Health for the first offense of not more than $10,000 and
for a second or subsequent offense of not less than $10,000 nor more than
$20,000. Unless otherwise required by federal law, the State Board of
Health shall deposit all civil penalties collected pursuant to this
section into a separate account in the State General Fund to be used for
the enforcement of this section and the protection of the health, safety,
well-being and property of residences of residential facilities for
groups.
5. This section does not apply to a medical facility that is
licensed pursuant to NRS 449.001 to
449.240 , inclusive, on October 1, 1999.
(Added to NRS by 1999, 3606 )
No person,
state or local government or agency may represent that it provides
“hospice care” unless the program of care, either directly or indirectly:
1. Has a medical director whose responsibilities are appropriate
to the needs of the program and who:
(a) Is a physician, currently licensed to practice;
(b) On the basis of training, experience and interest, is
knowledgeable about the psychosocial and medical aspects of hospice; and
(c) Acts as a medical resource to the interdisciplinary team which
provides the hospice care;
2. Is provided to the patient, as needed, in the patient’s home,
at a residential facility and at a medical facility, at any time of the
day or night;
3. Includes medical, nursing, psychological and pastoral care and
social services at the level required by the patient’s condition;
4. Provides supportive services for the patient’s immediate family
and other persons with significant personal ties to the patient, whether
or not related by blood, including:
(a) Care for the patient which provides a respite from the stresses
and responsibilities that result from the daily care of the patient; and
(b) Emotional support and other care after the patient dies; and
5. Includes the services of trained volunteers.
(Added to NRS by 1989, 1034)
1. A licensed facility for hospice care may provide any of the
following levels of care for terminally ill patients:
(a) Medical care for a patient who is in an acute episode of
illness;
(b) Skilled nursing care;
(c) Intermediate care;
(d) Custodial care; and
(e) Palliative services.
2. A licensed facility for hospice care may provide direct
supportive services to a patient’s family and persons who provide care
for the patient, including services which provide care for the patient
during the day and other services which provide a respite from the
stresses and responsibilities that result from the daily care of the
patient.
(Added to NRS by 1989, 1034; A 1999, 249 ; 2005, 485 )
No dentist may be:
1. Automatically admitted to membership on the medical staff of a
hospital solely because he is licensed as a dentist in this state or is
authorized pursuant to NRS 631.267 to
perform certain functions; or
2. Denied admission to membership on the medical staff of a
hospital merely because he is licensed as a dentist and not as a
physician.
(Added to NRS by 1985, 2097)
An independent center to
provide emergency medical care shall not be operated unless a physician
and registered nurse are on the premises.
(Added to NRS by 1985, 1735)
1. Except as otherwise provided in subsection 2, a facility for
skilled nursing or facility for intermediate care licensed pursuant to
the provisions of NRS 449.001 to
449.240 , inclusive, may not be operated
except under the supervision of a nursing facility administrator who is
at the facility and licensed under the provisions of chapter 654 of NRS.
2. The provisions of subsection 1 do not apply to a facility for
intermediate care which limits its care and treatment to those persons
who are mentally retarded or who have conditions related to mental
retardation.
(Added to NRS by 1969, 672; A 1971, 934; 1973, 1281; 1977, 1031;
1985, 1738; 1993, 1214)
A
residential facility for groups must not be operated except under the
supervision of an administrator of a residential facility for groups
licensed pursuant to the provisions of chapter 654 of NRS.
(Added to NRS by 1993, 2144)
[Effective through June 30, 2007.] Each alcohol and
drug abuse program operated or provided by a facility for transitional
living for released offenders must be certified by the Health Division in
accordance with the requirements set forth in chapter 458 of NRS and any regulations adopted pursuant thereto.
As used in this section, “alcohol and drug abuse program” has the meaning
ascribed to it in NRS 458.010 .
(Added to NRS by 2005, 2350 )
[Effective July 1, 2007.] Each alcohol and drug
abuse program operated or provided by a facility for transitional living
for released offenders must be certified by the Division of Mental Health
and Developmental Services of the Department of Health and Human Services
in accordance with the requirements set forth in chapter 458 of NRS and any regulations adopted pursuant thereto.
As used in this section, “alcohol and drug abuse program” has the meaning
ascribed to it in NRS 458.010 .
(Added to NRS by 2005, 2350 ; A 2005, 22nd Special Session, 67 , effective July 1, 2007)
1. The Board shall establish minimum continuing education
requirements concerning the care of persons with any form of dementia,
including, without limitation, dementia caused by Alzheimer’s disease,
for each person who is:
(a) Employed by a facility for skilled nursing, facility for
intermediate care or residential facility for groups which provides care
to persons with any form of dementia; and
(b) Licensed or certified by an occupational licensing board.
2. In establishing continuing education requirements pursuant to
subsection 1, the Board shall consider any other educational requirements
imposed on such employees to ensure that the continuing education
requirements established by the Board do not duplicate or conflict with
the existing educational requirements imposed on those employees.
3. The administrator of a facility for skilled nursing, facility
for intermediate care or residential facility for groups which provides
care to persons with any form of dementia, including, without limitation,
dementia caused by Alzheimer’s disease, shall ensure that each employee
of the facility who is required to comply with the requirements for
continuing education established by the Board pursuant to this section
complies with such requirements.
(Added to NRS by 2003, 856 )
An obstetric
center must:
1. Provide sufficient space for members of the family of the
pregnant woman and other persons chosen by the woman to assist her with
the birth; and
2. Have obstetrical services available to meet the needs of an
acute patient.
(Added to NRS by 1985, 1735)
1. The Board shall adopt:
(a) Licensing standards for each class of medical facility or
facility for the dependent covered by NRS 449.001 to 449.240 ,
inclusive, and for programs of hospice care.
(b) Regulations governing the licensing of such facilities and
programs.
(c) Regulations governing the procedure and standards for granting
an extension of the time for which a natural person may provide certain
care in his home without being considered a residential facility for
groups pursuant to NRS 449.017 . The
regulations must require that such grants are effective only if made in
writing.
(d) Regulations establishing a procedure for the indemnification by
the Health Division, from the amount of any surety bond or other
obligation filed or deposited by a facility for refractive surgery
pursuant to NRS 449.068 or 449.069
, of a patient of the facility who has
sustained any damages as a result of the bankruptcy of or any breach of
contract by the facility.
(e) Any other regulations as it deems necessary or convenient to
carry out the provisions of NRS 449.001
to 449.240 , inclusive.
2. The Board shall adopt separate regulations governing the
licensing and operation of:
(a) Facilities for the care of adults during the day; and
(b) Residential facilities for groups,
Ê which provide care to persons with Alzheimer’s disease.
3. The Board shall adopt separate regulations for:
(a) The licensure of rural hospitals which take into consideration
the unique problems of operating such a facility in a rural area.
(b) The licensure of facilities for refractive surgery which take
into consideration the unique factors of operating such a facility.
(c) The licensure of mobile units which take into consideration the
unique factors of operating a facility that is not in a fixed location.
4. The Board shall require that the practices and policies of each
medical facility or facility for the dependent provide adequately for the
protection of the health, safety and physical, moral and mental
well-being of each person accommodated in the facility.
5. The Board shall establish minimum qualifications for
administrators and employees of residential facilities for groups. In
establishing the qualifications, the Board shall consider the related
standards set by nationally recognized organizations which accredit such
facilities.
6. The Board shall adopt separate regulations regarding the
assistance which may be given pursuant to NRS 453.375 and 454.213
to an ultimate user of controlled substances or dangerous drugs by
employees of residential facilities for groups. The regulations must
require at least the following conditions before such assistance may be
given:
(a) The ultimate user’s physical and mental condition is stable and
is following a predictable course.
(b) The amount of the medication prescribed is at a maintenance
level and does not require a daily assessment.
(c) A written plan of care by a physician or registered nurse has
been established that:
(1) Addresses possession and assistance in the
administration of the medication; and
(2) Includes a plan, which has been prepared under the
supervision of a registered nurse or licensed pharmacist, for emergency
intervention if an adverse condition results.
(d) The prescribed medication is not administered by injection or
intravenously.
(e) The employee has successfully completed training and
examination approved by the Health Division regarding the authorized
manner of assistance.
7. The Board shall adopt separate regulations governing the
licensing and operation of residential facilities for groups which
provide assisted living services. The Board shall not allow the licensing
of a facility as a residential facility for groups which provides
assisted living services and a residential facility for groups shall not
claim that it provides “assisted living services” unless:
(a) Before authorizing a person to move into the facility, the
facility makes a full written disclosure to the person regarding what
services of personalized care will be available to the person and the
amount that will be charged for those services throughout the resident’s
stay at the facility.
(b) The residents of the facility reside in their own living units
which:
(1) Except as otherwise provided in subsection 8, contain
toilet facilities;
(2) Contain a sleeping area or bedroom; and
(3) Are shared with another occupant only upon consent of
both occupants.
(c) The facility provides personalized care to the residents of the
facility and the general approach to operating the facility incorporates
these core principles:
(1) The facility is designed to create a residential
environment that actively supports and promotes each resident’s quality
of life and right to privacy;
(2) The facility is committed to offering high-quality
supportive services that are developed by the facility in collaboration
with the resident to meet the resident’s individual needs;
(3) The facility provides a variety of creative and
innovative services that emphasize the particular needs of each
individual resident and his personal choice of lifestyle;
(4) The operation of the facility and its interaction with
its residents supports, to the maximum extent possible, each resident’s
need for autonomy and the right to make decisions regarding his own life;
(5) The operation of the facility is designed to foster a
social climate that allows the resident to develop and maintain personal
relationships with fellow residents and with persons in the general
community;
(6) The facility is designed to minimize and is operated in
a manner which minimizes the need for its residents to move out of the
facility as their respective physical and mental conditions change over
time; and
(7) The facility is operated in such a manner as to foster a
culture that provides a high-quality environment for the residents, their
families, the staff, any volunteers and the community at large.
8. The Health Division may grant an exception from the requirement
of subparagraph (1) of paragraph (b) of subsection 7 to a facility
licensed as a residential facility for groups on or before July 1, 2005,
and which is authorized to have 10 or fewer beds and was originally
constructed as a single-family dwelling, if the Health Division finds
that:
(a) Strict application of that requirement would result in economic
hardship to the facility requesting the exception; and
(b) The exception, if granted, would not:
(1) Cause substantial detriment to the health or welfare of
any resident of the facility;
(2) Result in more than two residents sharing a toilet
facility; or
(3) Otherwise impair substantially the purpose of that
requirement.
9. The Board shall, if it determines necessary, adopt regulations
and requirements to ensure that each residential facility for groups and
its staff are prepared to respond to an emergency, including, without
limitation:
(a) The adoption of plans to respond to a natural disaster and
other types of emergency situations, including, without limitation, an
emergency involving fire;
(b) The adoption of plans to provide for the evacuation of a
residential facility for groups in an emergency, including, without
limitation, plans to ensure that nonambulatory patients may be evacuated;
(c) Educating the residents of residential facilities for groups
concerning the plans adopted pursuant to paragraphs (a) and (b); and
(d) Posting the plans or a summary of the plans adopted pursuant to
paragraphs (a) and (b) in a conspicuous place in each residential
facility for groups.
10. The regulations governing the licensing and operation of
facilities for transitional living for released offenders must provide
for the licensure of at least three different types of facilities,
including, without limitation:
(a) Facilities that only provide a housing and living environment;
(b) Facilities that provide or arrange for the provision of
supportive services for residents of the facility to assist the residents
with reintegration into the community, in addition to providing a housing
and living environment; and
(c) Facilities that provide or arrange for the provision of alcohol
and drug abuse programs, in addition to providing a housing and living
environment and providing or arranging for the provision of other
supportive services.
11. As used in this section, “living unit” means an individual
private accommodation designated for a resident within the facility.
(Added to NRS by 1969, 946; A 1971, 934; 1973, 1281; 1985, 1738;
1987, 990; 1989, 1036, 2155, 2156; 1991, 1975; 1993, 1214; 1995, 1600;
1999, 3608 ; 2001, 1341 ; 2003, 1921 ; 2005, 2165 , 2350 , 2693 )
The Board may adopt
regulations requiring the licensing of a facility other than those
required to be licensed pursuant to NRS 449.001 to 449.240 ,
inclusive, if the:
1. Facility provides any type of medical care or treatment; and
2. Regulation is necessary to protect the health of the general
public.
(Added to NRS by 1985, 1735)
Any
person, state or local government or agency thereof desiring a license
under the provisions of NRS 449.001 to
449.240 , inclusive, must file with the
Health Division an application on a form prescribed, prepared and
furnished by the Health Division, containing:
1. The name of the applicant and, if a natural person, whether the
applicant has attained the age of 21 years.
2. The type of facility to be operated.
3. The location of the facility.
4. In specific terms, the nature of services and type of care to
be offered, as defined in the regulations.
5. The number of beds authorized by the Director of the Department
of Health and Human Services or, if such authorization is not required,
the number of beds the facility will contain.
6. The name of the person in charge of the facility.
7. Such other information as may be required by the Health
Division for the proper administration and enforcement of NRS 449.001
to 449.240 , inclusive.
8. Evidence satisfactory to the Health Division that the applicant
is of reputable and responsible character. If the applicant is a firm,
association, organization, partnership, business trust, corporation or
company, similar evidence must be submitted as to the members thereof,
and the person in charge of the facility for which application is made.
If the applicant is a political subdivision of the State or other
governmental agency, similar evidence must be submitted as to the person
in charge of the institution for which application is made.
9. Evidence satisfactory to the Health Division of the ability of
the applicant to comply with the provisions of NRS 449.001 to 449.240 ,
inclusive, and the standards and regulations adopted by the Board.
10. Evidence satisfactory to the Health Division that the facility
conforms to the zoning regulations of the local government within which
the facility will be operated or that the applicant has applied for an
appropriate reclassification, variance, permit for special use or other
exception for the facility.
[2:336:1951]—(NRS A 1963, 959; 1971, 934; 1973, 1281; 1975, 367;
1985, 1739; 1987, 776; 1991, 1078)
1. Except as otherwise provided in subsection 2, each application
for a license must be accompanied by such fee as may be determined by
regulation of the Board. The Board may, by regulation, allow or require
payment of a fee for a license in installments and may fix the amount of
each payment and the date that the payment is due.
2. A facility for the care of adults during the day is exempt from
the fees imposed by the Board pursuant to this section.
3. The fee imposed by the Board for a facility for transitional
living for released offenders must be based on the type of facility that
is being licensed and must be calculated to produce the revenue estimated
to cover the costs related to the license, but in no case may a fee for a
license exceed the actual cost to the Health Division of issuing or
renewing the license.
4. If an application for a license for a facility for transitional
living for released offenders is denied, any amount of the fee paid
pursuant to this section that exceeds the expenses and costs incurred by
the Health Division must be refunded to the applicant.
[Part 3:336:1951]—(NRS A 1971, 935; 1973, 1282; 1985, 1739; 1995,
501; 2003, 580 ; 2005, 2352 )
1. Each license issued pursuant to NRS 449.001 to 449.240 ,
inclusive, expires on December 31 following its issuance and is renewable
for 1 year upon reapplication and payment of all fees required pursuant
to NRS 449.050 unless the Health
Division finds, after an investigation, that the facility has not:
(a) Satisfactorily complied with the provisions of NRS 449.001
to 449.240 , inclusive, or the standards and regulations
adopted by the Board;
(b) Obtained the approval of the Director of the Department of
Health and Human Services before undertaking a project, if such approval
is required by NRS 439A.100 ; or
(c) Conformed to all applicable local zoning regulations.
2. Each reapplication for an agency to provide personal care
services in the home, an agency to provide nursing in the home, a
residential facility for intermediate care, a facility for skilled
nursing or a residential facility for groups must include, without
limitation, a statement that the facility or agency is in compliance with
the provisions of NRS 449.173 to
449.188 , inclusive.
[Part 3:336:1951]—(NRS A 1963, 959; 1971, 935; 1973, 1282; 1985,
1739; 1987, 777; 1991, 1078; 1995, 1490; 1997, 445; 2003, 580 ; 2005, 2167 )
As used in this section and
NRS 449.065 and 449.067 , “older patient” means a patient who is 60
years of age or older.
(Added to NRS by 1997, 1482)
1. Except as otherwise provided in subsections 6 and 7 and NRS
449.067 , each facility for intermediate
care, facility for skilled nursing, residential facility for groups,
agency to provide personal care services in the home and agency to
provide nursing in the home shall, when applying for a license or
renewing a license, file with the Administrator of the Health Division a
surety bond:
(a) If the facility or agency employs less than 7 employees, in the
amount of $5,000;
(b) If the facility or agency employs at least 7 but not more than
25 employees, in the amount of $25,000; or
(c) If the facility or agency employs more than 25 employees, in
the amount of $50,000.
2. A bond filed pursuant to this section must be executed by the
facility or agency as principal and by a surety company as surety. The
bond must be payable to the Aging Services Division of the Department of
Health and Human Services and must be conditioned to provide
indemnification to an older patient who the Specialist for the Rights of
Elderly Persons determines has suffered property damage as a result of
any act or failure to act by the facility or agency to protect the
property of the older patient.
3. Except when a surety is released, the surety bond must cover
the period of the initial license to operate or the period of the
renewal, as appropriate.
4. A surety on any bond filed pursuant to this section may be
released after the surety gives 30 days’ written notice to the
Administrator of the Health Division, but the release does not discharge
or otherwise affect any claim filed by an older patient for property
damaged as a result of any act or failure to act by the facility or
agency to protect the property of the older patient alleged to have
occurred while the bond was in effect.
5. A license is suspended by operation of law when the facility or
agency is no longer covered by a surety bond as required by this section
or by a substitute for the surety bond pursuant to NRS 449.067 . The Administrator of the Health Division
shall give the facility or agency at least 20 days’ written notice before
the release of the surety or the substitute for the surety, to the effect
that the license will be suspended by operation of law until another
surety bond or substitute for the surety bond is filed in the same manner
and amount as the bond or substitute being terminated.
6. The Administrator of the Health Division may exempt a
residential facility for groups from the requirement of filing a surety
bond pursuant to this section if the Administrator determines that the
requirement would result in undue hardship to the residential facility
for groups.
7. The requirement of filing a surety bond set forth in this
section does not apply to a facility for intermediate care, facility for
skilled nursing, residential facility for groups, agency to provide
personal care services in the home or agency to provide nursing in the
home that is operated and maintained by the State of Nevada or an agency
thereof.
(Added to NRS by 1997, 1482; A 2003, 524 ; 2005, 2168 )
1. As a substitute for the surety bond required pursuant to NRS
449.065 , a facility for intermediate
care, a facility for skilled nursing, a residential facility for groups,
an agency to provide personal care services in the home and an agency to
provide nursing in the home may deposit with any bank or trust company
authorized to do business in this State, upon approval from the
Administrator of the Health Division:
(a) An obligation of a bank, savings and loan association, thrift
company or credit union licensed to do business in this State;
(b) Bills, bonds, notes, debentures or other obligations of the
United States or any agency or instrumentality thereof, or guaranteed by
the United States; or
(c) Any obligation of this State or any city, county, town,
township, school district or other instrumentality of this State, or
guaranteed by this State, in an aggregate amount, based upon principal
amount or market value, whichever is lower.
2. The obligations of a bank, savings and loan association, thrift
company or credit union must be held to secure the same obligation as
would the surety bond required by NRS 449.065 . With the approval of the Administrator of the
Health Division, the depositor may substitute other suitable obligations
for those deposited, which must be assigned to the Aging Services
Division of the Department of Health and Human Services and are
negotiable only upon approval by the Administrator of the Aging Services
Division.
3. Any interest or dividends earned on the deposit accrue to the
account of the depositor.
4. The deposit must be an amount at least equal to the surety bond
required by NRS 449.065 and must state
that the amount may not be withdrawn except by direct and sole order of
the Administrator of the Aging Services Division.
(Added to NRS by 1997, 1483; A 2003, 525 ; 2005, 2169 )
1. Except as otherwise provided in NRS 449.069 , each facility for refractive surgery shall,
when applying for a license or renewing a license, file with the
Administrator of the Health Division a surety bond:
(a) If the facility employs less than 7 employees, in the amount of
$10,000;
(b) If the facility employs at least 7 but not more than 25
employees, in the amount of $50,000; or
(c) If the facility employs more than 25 employees, in the amount
of $100,000.
2. A bond filed pursuant to this section must be executed by the
facility as principal and by a surety company as surety. The bond must be
payable to the Health Division and must be conditioned to provide
indemnification to a patient of the facility who the Administrator of the
Health Division or his designee determines has sustained any damages as a
result of the bankruptcy of or any breach of contract by the facility.
3. Except when a surety is released, the surety bond must cover
the period of the initial license to operate or the period of the
renewal, as appropriate.
4. A surety on any bond filed pursuant to this section may be
released after the surety gives 30 days’ written notice to the
Administrator of the Health Division, but the release does not discharge
or otherwise affect any claim filed by a patient for any damages
sustained as a result of the bankruptcy of or any breach of contract by
the facility while the bond was in effect.
5. The license of a facility for refractive surgery is suspended
by operation of law when the facility is no longer covered by a surety
bond as required by this section or by a substitute for the surety bond
pursuant to NRS 449.069 . The
Administrator of the Health Division shall give the facility at least 20
days’ written notice before the release of the surety or the substitute
for the surety, to the effect that the license will be suspended by
operation of law until another surety bond is filed or substitute for the
surety bond is deposited in the same manner and amount as the bond or
substitute being terminated.
(Added to NRS by 2001, 1340 ; A 2005, 2696 )
1. As a substitute for the surety bond required pursuant to NRS
449.068 , a facility for refractive
surgery may deposit with any bank or trust company authorized to do
business in this State, upon approval of the Administrator of the Health
Division:
(a) An obligation of a bank, savings and loan association, thrift
company or credit union licensed to do business in this State;
(b) Bills, bonds, notes, debentures or other obligations of the
United States or any agency or instrumentality thereof, or guaranteed by
the United States; or
(c) Any obligation of this State or any city, county, town,
township, school district or other instrumentality of this State, or
guaranteed by this State, in an aggregate amount, based upon principal
amount or market value, whichever is lower.
2. The obligations of a bank, savings and loan association, thrift
company or credit union must be held to secure the same obligation as
would the surety bond required by NRS 449.068 . With the approval of the Administrator of the
Health Division, the facility may substitute other suitable obligations
for those deposited, which must be assigned to the Health Division and
are negotiable only upon approval of the Administrator of the Health
Division.
3. Any interest or dividends earned on the deposit accrue to the
account of the facility.
4. The deposit must be an amount at least equal to the surety bond
required by NRS 449.068 and must state
that the amount may not be withdrawn except by the direct and sole order
of the Administrator of the Health Division.
(Added to NRS by 2001, 1340 ; A 2005, 2696 )
001 to 449.240 ,
inclusive. The provisions of NRS 449.001 to 449.240 ,
inclusive, do not apply to:
1. Any facility conducted by and for the adherents of any church
or religious denomination for the purpose of providing facilities for the
care and treatment of the sick who depend solely upon spiritual means
through prayer for healing in the practice of the religion of the church
or denomination, except that such a facility shall comply with all
regulations relative to sanitation and safety applicable to other
facilities of a similar category.
2. Foster homes as defined in NRS 424.014 .
3. Any medical facility or facility for the dependent operated and
maintained by the United States Government or an agency thereof.
[Part 3:336:1951] + [7:336:1951]—(NRS A 1971, 935; 1973, 1282;
1979, 887; 1985, 1740; 1993, 2724; 2003, 857 ; 2005, 2169 )
1. If, after investigation, the Health Division finds that the:
(a) Applicant is in full compliance with the provisions of NRS
449.001 to 449.240 , inclusive;
(b) Applicant is in substantial compliance with the standards and
regulations adopted by the Board;
(c) Applicant, if he has undertaken a project for which approval is
required pursuant to NRS 439A.100 ,
has obtained the approval of the Director of the Department of Health and
Human Services; and
(d) Facility conforms to the applicable zoning regulations,
Ê the Health Division shall issue the license to the applicant.
2. A license applies only to the person to whom it is issued, is
valid only for the premises described in the license and is not
transferable.
[Part 3:336:1951]—(NRS A 1963, 959; 1971, 935; 1973, 1283; 1985,
1740; 1987, 777; 1991, 1078)
Each license issued by the
Health Division shall be in the form prescribed by the Division and shall
contain:
1. The name of the person or persons authorized to operate such
licensed facility;
2. The location of such licensed facility; and
3. The number of beds authorized in such licensed facility, the
nature of services offered and the service delivery capacity.
(Added to NRS by 1973, 1279; A 1975, 367)
1. A licensee must obtain the approval of the Health Division to
amend his license to operate a facility before the addition of any of the
following services:
(a) The intensive care of newborn babies.
(b) The treatment of burns.
(c) The transplant of organs.
(d) The performance of open-heart surgery.
(e) A center for the treatment of trauma.
2. The Health Division shall approve an application to amend a
license to allow a facility to provide any of the services described in
subsection 1 if the applicant satisfies the requirements contained in NRS
449.080 . The Health Division may revoke
its approval if the licensee fails to maintain substantial compliance
with standards approved by the Board for the provision of such services,
or with any conditions included in the written approval of the Director
issued pursuant to the provisions of NRS 439A.100 .
3. The Board shall consider standards adopted by appropriate
national organizations as a guide for adopting standards for the approval
of the provision of services pursuant to this section.
(Added to NRS by 1987, 876; A 1989, 1948)
1. The Health Division may cancel the license of a medical
facility or facility for the dependent and issue a provisional license,
effective for a period determined by the Health Division, to such a
facility if it:
(a) Is in operation at the time of the adoption of standards and
regulations pursuant to the provisions of NRS 449.001 to 449.240 ,
inclusive, and the Health Division determines that the facility requires
a reasonable time under the particular circumstances within which to
comply with the standards and regulations; or
(b) Has failed to comply with the standards or regulations and the
Health Division determines that the facility is in the process of making
the necessary changes or has agreed to make the changes within a
reasonable time.
2. The provisions of subsection 1 do not require the issuance of a
license or prevent the Health Division from refusing to renew or from
revoking or suspending any license where the Health Division deems such
action necessary for the health and safety of the occupants of any
facility.
(Added to NRS by 1973, 1279; A 1985, 1740)
A person who operates a residential
facility for groups shall:
1. Post his license to operate the residential facility for
groups; and
2. Post the rates for services provided by the residential
facility for groups,
Ê in a conspicuous place in the residential facility for groups.
(Added to NRS by 1999, 3606 )
1. Money received from licensing medical facilities and facilities
for the dependent must be forwarded to the State Treasurer for deposit in
the State General Fund.
2. The Health Division shall enforce the provisions of NRS 449.001
to 449.245 , inclusive, and may incur any necessary
expenses not in excess of money appropriated for that purpose by the
State or received from the Federal Government.
[11:336:1951] + [13:336:1951]—(NRS A 1963, 960; 1971, 936; 1973,
1283; 1975, 898; 1979, 209; 1985, 1741)
The Health Division may:
1. Upon receipt of an application for a license, conduct an
investigation into the premises, facilities, qualifications of personnel,
methods of operation, policies and purposes of any person proposing to
engage in the operation of a medical facility or a facility for the
dependent. The facility is subject to inspection and approval as to
standards for safety from fire, on behalf of the Health Division, by the
State Fire Marshal.
2. Upon receipt of a complaint against a medical facility or
facility for the dependent, except for a complaint concerning the cost of
services, conduct an investigation into the premises, facilities,
qualifications of personnel, methods of operation, policies, procedures
and records of that facility or any other medical facility or facility
for the dependent which may have information pertinent to the complaint.
3. Employ such professional, technical and clerical assistance as
it deems necessary to carry out the provisions of NRS 449.001 to 449.245 ,
inclusive.
[Part 6:336:1951]—(NRS A 1963, 960; 1969, 945; 1971, 936; 1973,
1284; 1975, 898; 1977, 642; 1985, 1220)
1. The Health Division may deny an application for a license or
may suspend or revoke any license issued under the provisions of NRS
449.001 to 449.240 , inclusive, upon any of the following grounds:
(a) Violation by the applicant or the licensee of any of the
provisions of NRS 439B.410 or 449.001
to 449.245 , inclusive, or of any other law of this State
or of the standards, rules and regulations adopted thereunder.
(b) Aiding, abetting or permitting the commission of any illegal
act.
(c) Conduct inimical to the public health, morals, welfare and
safety of the people of the State of Nevada in the maintenance and
operation of the premises for which a license is issued.
(d) Conduct or practice detrimental to the health or safety of the
occupants or employees of the facility.
(e) Failure of the applicant to obtain written approval from the
Director of the Department of Health and Human Services as required by
NRS 439A.100 or as provided in any
regulation adopted pursuant to this chapter, if such approval is required.
2. In addition to the provisions of subsection 1, the Health
Division may revoke a license to operate a facility for the dependent if,
with respect to that facility, the licensee that operates the facility,
or an agent or employee of the licensee:
(a) Is convicted of violating any of the provisions of NRS 202.470
;
(b) Is ordered to but fails to abate a nuisance pursuant to NRS
244.360 , 244.3603 or 268.4124 ; or
(c) Is ordered by the appropriate governmental agency to correct a
violation of a building, safety or health code or regulation but fails to
correct the violation.
3. The Health Division shall maintain a log of any complaints that
it receives relating to activities for which the Health Division may
revoke the license to operate a facility for the dependent pursuant to
subsection 2.
4. On or before February 1 of each odd-numbered year, the Health
Division shall submit to the Director of the Legislative Counsel Bureau a
written report setting forth, for the previous biennium:
(a) Any complaints included in the log maintained by the Health
Division pursuant to subsection 3; and
(b) Any disciplinary actions taken by the Health Division pursuant
to subsection 2.
[Part 6:336:1951] + [Part 8:336:1951]—(NRS A 1963, 960; 1971, 936;
1973, 1284; 1975, 898; 1977, 257; 1981, 1220; 1987, 1783; 1989, 1662;
1991, 1079; 2001, 1350 ; 2003, 47 , 857 )
1. If a medical facility or facility for the dependent violates
any provision related to its licensure, including any provision of NRS
439B.410 , 449.001 to 449.240 ,
inclusive, or any condition, standard or regulation adopted by the Board,
the Health Division in accordance with the regulations adopted pursuant
to NRS 449.165 may:
(a) Prohibit the facility from admitting any patient until it
determines that the facility has corrected the violation;
(b) Limit the occupancy of the facility to the number of beds
occupied when the violation occurred, until it determines that the
facility has corrected the violation;
(c) Impose an administrative penalty of not more than $1,000 per
day for each violation, together with interest thereon at a rate not to
exceed 10 percent per annum; and
(d) Appoint temporary management to oversee the operation of the
facility and to ensure the health and safety of the patients of the
facility, until:
(1) It determines that the facility has corrected the
violation and has management which is capable of ensuring continued
compliance with the applicable statutes, conditions, standards and
regulations; or
(2) Improvements are made to correct the violation.
2. If the facility fails to pay any administrative penalty imposed
pursuant to paragraph (c) of subsection 1, the Health Division may:
(a) Suspend the license of the facility until the administrative
penalty is paid; and
(b) Collect court costs, reasonable attorney’s fees and other costs
incurred to collect the administrative penalty.
3. The Health Division may require any facility that violates any
provision of NRS 439B.410 , 449.001
to 449.240 , inclusive, or any condition, standard or
regulation adopted by the Board, to make any improvements necessary to
correct the violation.
4. Any money collected as administrative penalties pursuant to
this section must be accounted for separately and used to protect the
health or property of the residents of the facility in accordance with
applicable federal standards.
(Added to NRS by 1989, 863; A 1989, 1663; 2003, 858 )
The
Board shall adopt regulations establishing the criteria for the
imposition of each sanction prescribed by NRS 449.163 . These regulations must:
1. Prescribe the circumstances and manner in which each sanction
applies;
2. Minimize the time between identification of a violation and the
imposition of a sanction;
3. Provide for the imposition of incrementally more severe
sanctions for repeated or uncorrected violations; and
4. Provide for less severe sanctions for lesser violations of
applicable state statutes, conditions, standards or regulations.
(Added to NRS by 1989, 864)
1. When the Health Division intends to deny, suspend or revoke a
license, or impose any sanction prescribed by NRS 449.163 , it shall give reasonable notice to all
parties by certified mail. The notice must contain the legal authority,
jurisdiction and reasons for the action to be taken. Notice is not
required if the Health Division finds that the public health requires
immediate action. In that case, it may order a summary suspension of a
license or impose any sanction prescribed by NRS 449.163 , pending proceedings for revocation or other
action.
2. If a person wants to contest the action of the Health Division,
he must file an appeal pursuant to regulations adopted by the Board.
3. Upon receiving notice of an appeal, the Health Division shall
hold a hearing pursuant to regulations adopted by the Board.
4. The Board shall adopt such regulations as are necessary to
carry out the provisions of this section.
[Part 8:336:1951]—(NRS A 1963, 960; 1969, 95; 1973, 1284; 1977, 70;
1985, 1741; 1989, 864; 1995, 1585)
If the Health Division suspends or
revokes the license of a person who operates a residential facility for
groups for abuse, neglect or isolation of the occupants of the facility,
the Division shall suspend or revoke the license of all residential
facilities for groups operated by that person. The person who operates
the facility shall move all of the persons who are receiving services in
the residential facilities for groups to other licensed residential
facilities for groups at his own expense.
(Added to NRS by 1999, 3607 )
The provisions
of NRS 449.176 to 449.188 , inclusive, do not apply to any facility for
the treatment of abuse of alcohol or drugs.
(Added to NRS by 1997, 442)
1. Each applicant for a license to operate a facility for
intermediate care, facility for skilled nursing or residential facility
for groups shall submit to the Central Repository for Nevada Records of
Criminal History two complete sets of fingerprints for submission to the
Federal Bureau of Investigation for its report.
2. The Central Repository for Nevada Records of Criminal History
shall determine whether the applicant has been convicted of a crime
listed in paragraph (a) of subsection 1 of NRS 449.188 and immediately inform the administrator of
the facility, if any, and the Health Division of whether the applicant
has been convicted of such a crime.
(Added to NRS by 1997, 442)
1. Except as otherwise provided in subsection 2, within 10 days
after hiring an employee or entering into a contract with an independent
contractor, the administrator of, or the person licensed to operate, an
agency to provide personal care services in the home, an agency to
provide nursing in the home, a facility for intermediate care, a facility
for skilled nursing or a residential facility for groups shall:
(a) Obtain a written statement from the employee or independent
contractor stating whether he has been convicted of any crime listed in
NRS 449.188 ;
(b) Obtain an oral and written confirmation of the information
contained in the written statement obtained pursuant to paragraph (a);
(c) Obtain from the employee or independent contractor two sets of
fingerprints and a written authorization to forward the fingerprints to
the Central Repository for Nevada Records of Criminal History for
submission to the Federal Bureau of Investigation for its report; and
(d) Submit to the Central Repository for Nevada Records of Criminal
History the fingerprints obtained pursuant to paragraph (c).
2. The administrator of, or the person licensed to operate, an
agency to provide personal care services in the home, an agency to
provide nursing in the home, a facility for intermediate care, a facility
for skilled nursing or a residential facility for groups is not required
to obtain the information described in subsection 1 from an employee or
independent contractor who provides proof that an investigation of his
criminal history has been conducted by the Central Repository for Nevada
Records of Criminal History within the immediately preceding 6 months and
the investigation did not indicate that the employee or independent
contractor had been convicted of any crime set forth in NRS 449.188
.
3. The administrator of, or the person licensed to operate, an
agency to provide personal care services in the home, an agency to
provide nursing in the home, a facility for intermediate care, a facility
for skilled nursing or a residential facility for groups shall ensure
that the criminal history of each employee or independent contractor who
works at the agency or facility is investigated at least once every 5
years. The administrator or person shall:
(a) If the agency or facility does not have the fingerprints of the
employee or independent contractor on file, obtain two sets of
fingerprints from the employee or independent contractor;
(b) Obtain written authorization from the employee or independent
contractor to forward the fingerprints on file or obtained pursuant to
paragraph (a) to the Central Repository for Nevada Records of Criminal
History for submission to the Federal Bureau of Investigation for its
report; and
(c) Submit the fingerprints to the Central Repository for Nevada
Records of Criminal History.
4. Upon receiving fingerprints submitted pursuant to this section,
the Central Repository for Nevada Records of Criminal History shall
determine whether the employee or independent contractor has been
convicted of a crime listed in NRS 449.188 and immediately inform the Health Division and
the administrator of, or the person licensed to operate, the agency or
facility at which the person works whether the employee or independent
contractor has been convicted of such a crime.
5. The Central Repository for Nevada Records of Criminal History
may impose a fee upon an agency or a facility that submits fingerprints
pursuant to this section for the reasonable cost of the investigation.
The agency or facility may recover from the employee or independent
contractor not more than one-half of the fee imposed by the Central
Repository. If the agency or facility requires the employee or
independent contractor to pay for any part of the fee imposed by the
Central Repository, it shall allow the employee or independent contractor
to pay the amount through periodic payments.
(Added to NRS by 1997, 442; A 1999, 1946 ; 2005, 2170 )
Each agency to provide personal care services in the home,
agency to provide nursing in the home, facility for intermediate care,
facility for skilled nursing and residential facility for groups shall
maintain accurate records of the information concerning its employees and
independent contractors collected pursuant to NRS 449.179 , and shall maintain a copy of the fingerprints
submitted to the Central Repository for Nevada Records of Criminal
History and proof that it submitted two sets of fingerprints to the
Central Repository for its report. These records must be made available
for inspection by the Health Division at any reasonable time and copies
thereof must be furnished to the Health Division upon request.
(Added to NRS by 1997, 443; A 1999, 1947 ; 2005, 2171 )
1. Upon receiving information from the Central Repository for
Nevada Records of Criminal History pursuant to NRS 449.179 , or evidence from any other source, that an
employee or independent contractor of an agency to provide personal care
services in the home, an agency to provide nursing in the home, a
facility for intermediate care, a facility for skilled nursing or a
residential facility for groups has been convicted of a crime listed in
paragraph (a) of subsection 1 of NRS 449.188 , the administrator of, or the person licensed
to operate, the agency or facility shall terminate the employment or
contract of that person after allowing him time to correct the
information as required pursuant to subsection 2.
2. If an employee or independent contractor believes that the
information provided by the Central Repository is incorrect, he may
immediately inform the agency or facility. An agency or facility that is
so informed shall give the employee or independent contractor a
reasonable amount of time of not less than 30 days to correct the
information received from the Central Repository before terminating the
employment or contract of the person pursuant to subsection 1.
3. An agency or facility that has complied with NRS 449.179 may not be held civilly or criminally liable
based solely upon the ground that the agency or facility allowed an
employee or independent contractor to work:
(a) Before it received the information concerning the employee or
independent contractor from the Central Repository;
(b) During any period required pursuant to subsection 2 to allow
the employee or independent contractor to correct that information;
(c) Based on the information received from the Central Repository,
if the information received from the Central Repository was inaccurate; or
(d) Any combination thereof.
Ê An agency or facility may be held liable for any other conduct
determined to be negligent or unlawful.
(Added to NRS by 1997, 443; A 1999, 1948 ; 2005, 2171 )
1. In addition to the grounds listed in NRS 449.160 , the Health Division may deny a license to
operate a facility for intermediate care, facility for skilled nursing or
residential facility for groups to an applicant or may suspend or revoke
the license of a licensee to operate such a facility if:
(a) The applicant or licensee has been convicted of:
(1) Murder, voluntary manslaughter or mayhem;
(2) Assault with intent to kill or to commit sexual assault
or mayhem;
(3) Sexual assault, statutory sexual seduction, incest,
lewdness, indecent exposure or any other sexually related crime;
(4) Abuse or neglect of a child or contributory delinquency;
(5) A violation of any federal or state law regulating the
possession, distribution or use of any controlled substance or any
dangerous drug as defined in chapter 454 of
NRS, within the past 7 years;
(6) A violation of any provision of NRS 200.50955 or 200.5099 ;
(7) Any offense involving fraud, theft, embezzlement,
burglary, robbery, fraudulent conversion or misappropriation of property,
within the immediately preceding 7 years; or
(8) Any other felony involving the use of a firearm or other
deadly weapon, within the immediately preceding 7 years; or
(b) The licensee has continued to employ a person who has been
convicted of a crime listed in paragraph (a).
2. In addition to the grounds listed in NRS 449.160 , the Health Division may deny a license to
operate an agency to provide personal care services in the home or an
agency to provide nursing in the home to an applicant or may suspend or
revoke the license of a licensee to operate such an agency if the
licensee has continued to employ a person who has been convicted of a
crime listed in paragraph (a) of subsection 1.
(Added to NRS by 1997, 444; A 1999, 1948 ; 2005, 2171 )
1. A hospital or other medical facility licensed under the
provisions of this chapter which is not operated by the State or a local
government or an agency of either is not required to permit the use of
its facilities for the induction or performance of an abortion, except in
a medical emergency.
2. Such refusal does not give rise to a cause of action in favor
of any person.
(Added to NRS by 1973, 897; A 1985, 1742)
A
medical facility shall not waive a deductible or copayment if:
1. The medical facility is not a preferred provider of health
care; and
2. The waiver would reduce the financial effect of a preferred
provider’s incentive or disincentive to its insureds.
(Added to NRS by 1987, 1783; A 1995, 1602)
The Health Division shall, upon request, disclose to any
person or governmental entity the results of its inspections of
facilities for skilled nursing, facilities for intermediate care and
residential facilities for groups regarding their compliance with
applicable regulations and standards.
[14:336:1951]—(NRS A 1963, 961; 1971, 936; 1973, 1285; 1987, 1054)
1. A medical facility or any agent or employee thereof shall not
retaliate or discriminate unfairly against:
(a) An employee of the medical facility or a person acting on
behalf of the employee who in good faith:
(1) Reports to the Board of Medical Examiners or the State
Board of Osteopathic Medicine, as applicable, information relating to the
conduct of a physician which may constitute grounds for initiating
disciplinary action against the physician or which otherwise raises a
reasonable question regarding the competence of the physician to practice
medicine with reasonable skill and safety to patients;
(2) Reports a sentinel event to the Health Division pursuant
to NRS 439.835 ; or
(3) Cooperates or otherwise participates in an investigation
or proceeding conducted by the Board of Medical Examiners, the State
Board of Osteopathic Medicine or another governmental entity relating to
conduct described in subparagraph (1) or (2).
(b) A registered nurse, licensed practical nurse or nursing
assistant who is employed by or contracts to provide nursing services for
the medical facility and who, in accordance with the policy, if any,
established by the medical facility:
(1) Reports to his immediate supervisor, in writing, that he
does not possess the knowledge, skill or experience to comply with an
assignment to provide nursing services to a patient; and
(2) Refuses to provide to a patient nursing services for
which, as verified by documentation in the personnel file of the
registered nurse, licensed practical nurse or nursing assistant
concerning his competence to provide various nursing services, he does
not possess the knowledge, skill or experience to comply with the
assignment to provide nursing services to the patient, unless such
refusal constitutes unprofessional conduct as set forth in chapter 632
of NRS or any regulations adopted pursuant
thereto.
2. A medical facility or any agent or employee thereof shall not
retaliate or discriminate unfairly against an employee of the medical
facility or a registered nurse, licensed practical nurse or nursing
assistant who is employed by or contracts to provide nursing services for
the medical facility because the employee, registered nurse, licensed
practical nurse or nursing assistant has taken an action described in
subsection 1.
3. A medical facility or any agent or employee thereof shall not
prohibit, restrict or attempt to prohibit or restrict by contract,
policy, procedure or any other manner the right of an employee of the
medical facility or a registered nurse, licensed practical nurse or
nursing assistant who is employed by or contracts to provide nursing
services for the medical facility to take an action described in
subsection 1.
4. As used in this section:
(a) “Physician” means a person licensed to practice medicine
pursuant to chapter 630 or 633 of NRS.
(b) “Retaliate or discriminate”:
(1) Includes, without limitation, the following action if
such action is taken solely because the employee or the registered nurse,
licensed practical nurse or nursing assistant took an action described in
subsection 1:
(I) Frequent or undesirable changes in the location
where the employee works;
(II) Frequent or undesirable transfers or
reassignments;
(III) The issuance of letters of reprimand, letters of
admonition or evaluations of poor performance;
(IV) A demotion;
(V) A reduction in pay;
(VI) The denial of a promotion;
(VII) A suspension;
(VIII) A dismissal;
(IX) A transfer; or
(X) Frequent changes in working hours or workdays.
(2) Does not include action described in sub-subparagraphs
(I) to (X), inclusive, of subparagraph (1) if the action is taken in the
normal course of employment or as a form of discipline.
(Added to NRS by 2002 Special Session, 16 ; A 2005, 1517 )
205 : Legal remedy. An employee of
a medical facility or a registered nurse, licensed practical nurse or
nursing assistant who is employed by or contracts to provide nursing
services for the medical facility who believes that he has been
retaliated or discriminated against in violation of NRS 449.205 may file an action in a court of competent
jurisdiction for such relief as may be appropriate under the law.
(Added to NRS by 2002 Special Session, 17 ; A 2005, 1518 )
1. Except as otherwise provided in subsections 2 and 3, a person
who operates a medical facility or facility for the dependent without a
license issued by the Health Division is guilty of a misdemeanor.
2. A person who operates a residential facility for groups without
a license issued by the Health Division:
(a) Is liable for a civil penalty to be recovered by the Attorney
General in the name of the Health Division for the first offense of not
more than $10,000 and for a second or subsequent offense of not less than
$10,000 nor more than $20,000;
(b) Shall be required to move all of the persons who are receiving
services in the residential facility for groups to a residential facility
for groups that is licensed at his own expense; and
(c) May not apply for a license to operate a residential facility
for groups for a period of 6 months after he is punished pursuant to this
section.
3. Unless otherwise required by federal law, the Health Division
shall deposit all civil penalties collected pursuant to this section into
a separate account in the State General Fund to be used for the
protection of the health, safety and well-being of patients, including
residents of residential facilities for groups.
[10:336:1951]—(NRS A 1967, 581; 1971, 936; 1973, 1285; 1985, 1742;
1999, 3609 )
1. The Health Division may bring an action in the name of the
State to enjoin any person, state or local government unit or agency
thereof from operating or maintaining any facility within the meaning of
NRS 449.001 to 449.240 , inclusive:
(a) Without first obtaining a license therefor; or
(b) After his license has been revoked or suspended by the Health
Division.
2. It is sufficient in such action to allege that the defendant
did, on a certain date and in a certain place, operate and maintain such
facility without a license.
[Part 6:336:1951]—(NRS A 1963, 961; 1971, 937; 1973, 1285)
1. Any authorized member or employee of the Health Division may
enter and inspect any building or premises at any time to secure
compliance with or prevent a violation of any provision of NRS 449.001
to 449.245 , inclusive.
2. The State Fire Marshal or his designee shall, upon receiving a
request from the Health Division or a written complaint concerning
compliance with the plans and requirements to respond to an emergency
adopted pursuant to subsection 9 of NRS 449.037 :
(a) Enter and inspect a residential facility for groups; and
(b) Make recommendations regarding the adoption of plans and
requirements pursuant to subsection 9 of NRS 449.037 ,
Ê to ensure the safety of the residents of the facility in an emergency.
3. The State Health Officer or his designee shall enter and
inspect at least annually each building or the premises of a residential
facility for groups to ensure compliance with standards for health and
sanitation.
4. An authorized member or employee of the Health Division shall
enter and inspect any building or premises operated by a residential
facility for groups within 72 hours after the Health Division is notified
that a residential facility for groups is operating without a license.
[Part 4:336:1951]—(NRS A 1963, 962; 1971, 937; 1973, 1286; 1975,
898; 1985, 1742; 1999, 3610 ; 2001, 1343 ; 2003, 421 , 1923 ; 2005, 2172 )
Every medical
facility or facility for the dependent may be inspected at any time, with
or without notice, as often as is necessary by:
1. The Health Division to ensure compliance with all applicable
regulations and standards; and
2. Any person designated by the Aging Services Division of the
Department of Health and Human Services to investigate complaints made
against the facility.
(Added to NRS by 1977, 642; A 1985, 1742; 1991, 1975; 2001, 1343
; 2003, 422 )
The district
attorney of the county in which the facility is located shall, upon
application by the Health Division, institute and conduct the prosecution
of any action for violation of any provisions of NRS 449.001 to 449.245 ,
inclusive.
[Part 8:336:1951]—(NRS A 1963, 962; 1971, 937; 1973, 1286; 1975,
899)
MISCELLANEOUS PROVISIONS
Every hospital licensed pursuant to the provisions of NRS
449.001 to 449.240 , inclusive:
1. May, except as otherwise provided in subsection 2, utilize the
Uniform Billing and Claims Forms established by the American Hospital
Association.
2. Shall, except as otherwise provided in this section, on its
billings to patients, itemize, on a daily basis, all charges for
services, and charges for equipment used and the supplies and medicines
provided incident to the provision of those services with specificity and
in language that is understandable to an ordinary lay person. This
itemized list must be timely provided after the patient is discharged at
no additional cost.
3. Except as otherwise provided in this subsection, if a patient
is charged a rate, pursuant to a contract or other agreement, that is
different than the billed charges, the hospital shall provide to the
patient either:
(a) A copy of the billing prepared pursuant to subsection 2;
(b) A statement specifying the agreed rate for the services; or
(c) If the patient is not obligated to pay any portion of the bill,
a statement of the total charges.
Ê In any case, the hospital shall include on the billing or statement any
copayment or deductible for which the patient is responsible. The
hospital shall answer any questions regarding the bill.
4. If the hospital is paid by the insurer of a patient a rate that
is based on the number of persons treated and not on the services
actually rendered, the hospital shall, upon the discharge of the patient,
advise the patient of the status of any copayment or deductible for which
the patient is responsible.
5. Shall prepare a summary of charges for common services for
patients admitted to the hospital and make it available to the public.
6. Shall provide to any patient upon request a copy of the billing
prepared pursuant to subsection 2.
(Added to NRS by 1975, 897; A 1983, 649; 1985, 905; 1993, 2427;
1995, 1856)
1. Any costs incurred by a hospital for:
(a) The examination of the victim of a sexual offense, when the
examination is performed for the purposes of gathering evidence for
possible prosecution of the person who committed the offense; or
(b) Initial emergency medical care for the victim,
Ê must not be charged directly to the victim. The costs must be charged
to the county in whose jurisdiction the offense was committed.
2. Whenever costs are incurred by a hospital for treatment which
has been approved by the board of county commissioners pursuant to NRS
217.310 for the victim of a sexual
assault and any other person eligible for treatment, the costs of the
treatment, not to exceed $1,000, must be charged to the county which
authorized the treatment. Any remainder must be handled the same as other
hospital costs.
(Added to NRS by 1975, 1133; A 1979, 587; 1985, 2106)
1. No hospital licensed under the provisions of NRS 449.001 to 449.240 ,
inclusive, may release from the hospital or otherwise surrender physical
custody of any child under 6 months of age, whose living parent or
guardian is known to the hospital, to any person other than a parent,
guardian or relative by blood or marriage of that child, without a
written authorization signed by a living parent, who must be the mother
if unwed, or guardian specifying the particular person or agency to whom
the child may be released and the permanent address of that person or
agency.
2. Upon the release or other surrender of physical custody of the
child, the hospital shall require from the person to whom the child is
released such reasonable proof of identity as the hospital may deem
necessary for compliance with the provisions of this section. The
hospital shall furnish a true copy of the written authorization to the
Division of Child and Family Services of the Department of Health and
Human Services before the release or other surrender by it of physical
custody of the child. The copy must be furnished to the Division
immediately upon receipt by the hospital.
3. Any person to whom any such child is released who thereafter
surrenders physical custody of that child to any other person or agency
shall, upon demand by the Division of Child and Family Services, disclose
to the Division the name and permanent address of the person or agency to
whom physical custody of the child was delivered.
4. All information received by the Division of Child and Family
Services pursuant to the provisions of this section is confidential and
must be protected from disclosure in the same manner that information is
protected under NRS 432.035 .
5. Compliance with the provisions of this section is not a
substitute for compliance with NRS 127.220 to 127.310 ,
inclusive, governing placements for adoption and permanent free care.
6. A violation of any provision of this section is a misdemeanor.
(Added to NRS by 1957, 251; A 1961, 739; 1963, 962; 1967, 1172;
1973, 1286, 1406; 1981, 721; 1993, 2724)
1. Before discharging an unmarried woman who has borne a child, a
hospital or obstetric center shall provide to the child’s mother and
father:
(a) The opportunity to sign, in the hospital, an affidavit for the
voluntary acknowledgment of paternity developed pursuant to NRS 440.283
;
(b) Written materials about establishing paternity;
(c) The forms necessary to acknowledge paternity voluntarily;
(d) A written description of the rights and responsibilities of
acknowledging paternity; and
(e) The opportunity to speak by telephone with personnel of the
program for enforcement of child support who are trained to clarify
information and answer questions about the establishment of paternity.
2. The Administrator of the Division of Welfare and Supportive
Services of the Department of Health and Human Services shall adopt the
regulations necessary to ensure that the services provided by a hospital
or obstetric center pursuant to this section are in compliance with the
regulations adopted by the Secretary of Health and Human Services
pursuant to 42 U.S.C. § 666(a)(5)(C).
(Added to NRS by 1995, 2426; A 1997, 2341)
The following persons
are entitled to access the results of tests performed at a licensed
laboratory regarding a patient of a rural hospital:
1. The patient;
2. The physician who ordered the tests; and
3. A provider of health care who is currently treating or
providing assistance in the treatment of the patient.
(Added to NRS by 1995, 1600)
1. The Health Division may review the personnel files of a medical
facility or facility for the dependent to determine that each nursing
assistant employed by the facility has a current certificate.
2. The Health Division shall review the qualifications of
instructors of nursing assistants for each program of which the Division
is notified pursuant to NRS 632.286 .
3. The Health Division may conduct the review of training programs
for nursing assistants in facilities for long-term care.
4. The Health Division and any other state agency which regulates
medical facilities and facilities for the dependent shall provide to the
State Board of Nursing any information it discovers concerning:
(a) Programs and instructors for training nursing assistants which
do not comply with the requirements established by the State Board of
Nursing.
(b) The failure of a nursing assistant to perform consistently at a
safe level.
(c) The results of any investigation of a facility if the
investigation concerns a nursing assistant or instructor or training
program for nursing assistants.
5. The State Board of Nursing shall investigate any report
submitted pursuant to subsection 4 and may revoke approval of a program
or instructor if the allegations of the report are true.
(Added to NRS by 1989, 2017)
An agency to provide nursing in the home shall,
in addition to skilled nursing, provide at least one of the following
services:
1. Speech or occupational therapy;
2. Guidance regarding nutrition or vocations;
3. Physical therapy;
4. Pharmaceutical services; or
5. Other social or medical services.
(Added to NRS by 1979, 160; A 1985, 1742)
1. A facility for skilled nursing or a facility for intermediate
care may return a prescription drug that is dispensed to a patient of the
facility, but will not be used by that patient, to the dispensing
pharmacy for the purpose of reissuing the drug to fill other
prescriptions for patients in that facility if:
(a) The drug is not a schedule II drug specified in or pursuant to
chapter 453 of NRS;
(b) The drug is dispensed in a unit dose, in individually sealed
doses or in a bottle sealed by the manufacturer of the drug;
(c) The drug is returned unopened and sealed in the original
manufacturer’s packaging or bottle;
(d) The usefulness of the drug has not expired;
(e) The packaging or bottle contains the expiration date of the
usefulness of the drug; and
(f) The name of the patient for whom the drug was originally
prescribed, the prescription number and any other identifying marks are
obliterated from the packaging or bottle before the return of the drug.
2. A dispensing pharmacy to which a drug is returned pursuant to
this section may reissue the drug to fill other prescriptions for
patients in the same facility if the registered pharmacist of the
pharmacy determines that the drug is suitable for that purpose in
accordance with standards adopted by the State Board of Pharmacy pursuant
to subsection 5.
3. No drug that is returned to a dispensing pharmacy pursuant to
this section may be used to fill other prescriptions more than one time.
4. A facility for skilled nursing or facility for intermediate
care shall adopt written procedures for returning drugs to a dispensing
pharmacy pursuant to this section. The procedures must:
(a) Provide appropriate safeguards for ensuring that the drugs are
not compromised or illegally diverted during their return.
(b) Require the maintenance and retention of such records relating
to the return of drugs to dispensing pharmacies as are required by the
State Board of Pharmacy.
(c) Be approved by the State Board of Pharmacy.
5. The State Board of Pharmacy shall adopt such regulations as are
necessary to carry out the provisions of this section, including, without
limitation, requirements for:
(a) Returning and reissuing such drugs pursuant to the provisions
of this section.
(b) Maintaining records relating to the return and the use of such
drugs to fill other prescriptions.
(Added to NRS by 2003, 1372 )
HOMES FOR INDIVIDUAL RESIDENTIAL CARE
1. A person, state or local government or agency thereof shall not
operate a home for individual residential care without first obtaining a
license for the home from the Health Division. An application for the
license must be made in the manner provided in NRS 449.040 .
2. The State Board of Health shall adopt minimal standards for
licensing that provide for care and sanitation to prevent the abuse,
neglect or exploitation of residents of homes for individual residential
care.
(Added to NRS by 1993, 2556; A 1999, 1050 )
The Health Division
and the Aging Services Division of the Department of Health and Human
Services may:
1. Investigate any complaints against a home for individual
residential care and, when conducting such an investigation, may inspect
the home during normal business hours, with or without notice.
2. Report to an appropriate state or local agency any violations
of state or local laws or regulations discovered during an investigation
conducted pursuant to this section.
(Added to NRS by 1993, 2556)
1. A person who operates or maintains a home for individual
residential care without a license issued by the Health Division pursuant
to NRS 449.249 is liable for a civil
penalty, to be recovered by the Attorney General in the name of the
Health Division, for the first offense of $10,000 and for a second or
subsequent offense of not less than $10,000 nor more than $20,000.
2. Unless otherwise required by federal law, the Health Division
shall deposit civil penalties collected pursuant to this section into a
separate account in the State General Fund in the State Treasury to be
used for the protection of the health, safety, well-being and property of
patients, including residents of facilities found deficient by the Health
Division.
3. A person against whom a civil penalty is assessed by the court
pursuant to subsection 1:
(a) Shall move, at his own expense, all persons receiving services
in the home for individual residential care to a licensed home for
individual residential care.
(b) May not apply for a license to operate a home for individual
residential care until 6 months have elapsed since the penalty was
assessed.
(Added to NRS by 1993, 2556; A 1999, 1051 )
NEVADA HEALTH FACILITIES ASSISTANCE ACT
NRS 449.250 to 449.430 ,
inclusive, may be cited as the Nevada Health Facilities Assistance Act.
[1:219:1949; 1943 NCL § 5285.01]—(NRS A 1965, 983)
As used in NRS 449.250 to 449.430 ,
inclusive:
1. “Community mental health center” means a facility providing
services for the prevention or diagnosis of mental illness, or care and
treatment of mentally ill patients, or rehabilitation of such persons,
which services are provided principally for persons residing in a
particular community in or near which the facility is situated.
2. “Construction” includes the construction of new buildings,
modernization, expansion, remodeling and alteration of existing
buildings, and initial equipment of such buildings, including medical
transportation facilities, and includes architects’ fees, but excludes
the cost of off-site improvements and, except with respect to public
health centers, the cost of the acquisition of the land.
3. “Facility for the mentally retarded” means a facility specially
designed for the diagnosis, treatment, education, training or custodial
care of the mentally retarded, including facilities for training
specialists and sheltered workshops for the mentally retarded, but only
if such workshops are part of facilities which provide or will provide
comprehensive services for the mentally retarded.
4. “Federal Act” means 42 U.S.C. §§ 291 to 291o-l, inclusive, and
300k to 300t, inclusive, and any other federal law providing for or
applicable to the provision of assistance for health facilities.
5. “Federal agency” means the federal department, agency or
official designated by law, regulation or delegation of authority to
administer the Federal Act.
6. “Health facility” includes a public health center, hospital,
facility for hospice care, facility for the mentally retarded, community
mental health center, and other facility to provide diagnosis, treatment,
care, rehabilitation, training or related services to persons with
physical or mental impairments, including diagnostic or diagnostic and
treatment centers, rehabilitation facilities and nursing homes, as those
terms are defined in the Federal Act, and such other facilities for which
federal aid may be authorized under the Federal Act, but, except for
facilities for the mentally retarded, does not include any facility
furnishing primarily domiciliary care.
7. “Nonprofit health facility” means any health facility owned and
operated by a corporation or association, no part of the net earnings of
which inures or may lawfully inure to the benefit of any private
shareholder or natural person.
8. “Public health center” means a publicly owned facility for the
provision of public health services, including related facilities such as
laboratories, clinics and administrative offices operated in connection
with public health centers.
9. “State Department” means the Department of Health and Human
Services, acting through its appropriate divisions.
[2:219:1949; A 1956, 47]—(NRS A 1963, 962; 1965, 983; 1967, 1173;
1973, 1406; 1975, 909; 1977, 258; 1979, 1113; 1985, 1743; 1989, 1036;
1999, 249 )
The State Department shall constitute the sole
agency of the State for the purpose of:
1. Inventorying existing health facilities, surveying the need for
construction of health facilities, and developing programs of health
facilities construction as provided in NRS 449.250 to 449.430 ,
inclusive.
2. Developing and administering state plans for the construction
of public and other nonprofit health facilities as provided in NRS
449.250 to 449.430 , inclusive.
3. Developing and administering any other plan or program
providing assistance to health facilities for which funds may be
available to this state under the Federal Act.
[3:219:1949; 1943 NCL § 5285.03]—(NRS A 1965, 985)
In carrying out the
purposes of NRS 449.250 to 449.430
, inclusive, the State Department is
authorized and directed:
1. To require such reports, make such inspections and
investigations, and prescribe such regulations as it deems necessary.
2. To provide such methods of administration, appoint all
necessary officers and other personnel and take such other action as may
be necessary to comply with the requirements of NRS 449.250 to 449.430 ,
inclusive, the Federal Act and the regulations thereunder.
3. To procure in its discretion the temporary or intermittent
services of experts or consultants, by contract, when such services are
to be performed on a part-time or fee-for-service basis and do not
involve the performance of administrative duties.
4. To the extent that it considers desirable to effectuate the
purposes of NRS 449.250 to 449.430
, inclusive, to enter into agreements
for the utilization of the facilities and services of other departments,
agencies and institutions, public or private.
5. To accept on behalf of the State and to deposit with the State
Treasurer in appropriate accounts in the Department of Health and Human
Services’ Gift Fund any grant, gift or contribution made to assist in
meeting the cost of carrying out the purposes of NRS 449.250 to 449.430 ,
inclusive, and to expend the same for such purposes.
6. To do all other things on behalf of the State necessary or
advisable to obtain the maximum benefits available under the Federal Act.
7. All claims must be approved by the Health Officer before they
are paid.
[4:219:1949; 1943 NCL § 5285.04]—(NRS A 1965, 985; 1969, 945; 1981,
79)
The State Department is
authorized and directed to inventory existing health facilities,
including public, nonprofit, and proprietary health facilities, to survey
the need for construction of health facilities, and, on the basis of such
inventory and survey, to develop programs for the construction of such
public and other nonprofit health facilities as will, in conjunction with
existing facilities, afford the necessary physical facilities for
furnishing adequate health facility services to all the people of the
State.
[7:219:1949; 1943 NCL § 5285.07]—(NRS A 1965, 986)
The construction programs must provide, in accordance with
NRS 449.250 to 449.430 , inclusive, and the regulations thereunder,
for adequate health facilities for the people residing in this State,
and, insofar as possible, must provide for their distribution throughout
the State in such manner as to make the services of all types of health
facilities reasonably accessible to all persons in the State.
[9:219:1949; 1943 NCL § 5285.09]—(NRS A 1965, 986; 1981, 1901)
1. The State Department may apply to the federal agency for
federal money to assist in carrying out the surveys, planning and
construction activities provided for in NRS 449.250 to 449.430 ,
inclusive.
2. The money must be deposited in the State Treasury and must be
available to the State Department for expenditure for carrying out the
purposes of NRS 449.250 to 449.430
, inclusive.
[8:219:1949; 1943 NCL § 5285.08]—(NRS A 1965, 987; 1981, 1901)
1. The State Department may, by regulation, establish standards
for the maintenance and operation of health facilities, which supersede
all local ordinances and regulations inconsistent therewith.
2. A copy of the regulations, giving the date that they take
effect, must be issued in pamphlet form.
3. Any health facility that applies for and accepts federal aid
for construction under a state plan does so on the condition that the
health facility qualify under the minimum standards for maintenance and
operation adopted and enforced by the State Department.
4. Any person, partnership, association or corporation
establishing, conducting, managing or operating any health facility
within the meaning of NRS 449.250 to
449.430 , inclusive, who violates any of
the provisions of this section or regulations lawfully adopted thereunder
is guilty of a misdemeanor.
[11:219:1949; 1943 NCL § 5285.11] + [12:219:1949; 1943 NCL §
5285.12]—(NRS A 1963, 963; 1965, 987; 1971, 937; 1985, 369)
1. Applications for health facility construction projects for
which federal funds are required must be submitted to the appropriate
health systems agency and the State Department. They may be submitted by
the State or any political subdivision thereof or by any public or
nonprofit agency authorized to construct and operate a health facility.
2. Each application for a construction project must conform to
federal and state requirements and must be submitted in the manner and
form prescribed by the State Department.
[14:219:1949; 1943 NCL § 5285.14]—(NRS A 1965, 988; 1979, 969)
1. The State Department shall afford to every applicant for
assistance for a construction project an opportunity for a fair hearing
before the State Department upon 10 days’ written notice to the applicant.
2. If the State Department, after affording reasonable opportunity
for development and presentation of applications in the order of relative
need, finds that an application is in conformity with the state plan, the
State Department shall approve the application and shall recommend and
forward it to the federal agency.
3. The State Department shall consider and forward applications in
the order of relative need set forth in the state plan.
[15:219:1949; 1943 NCL § 5285.15]—(NRS A 1965, 988; 1981, 856;
1985, 1362)
From time to time, the State
Department shall inspect each construction project approved by the
federal agency and, if the inspection so warrants, the State Department
shall certify to the federal agency that work has been performed upon the
project, or that purchases have been made, in accordance with the
approved plans and specifications, and that payment of an installment of
federal funds is due to the applicant.
[16:219:1949; 1943 NCL § 5285.16]—(NRS A 1965, 988)
1. The State Department is hereby authorized to receive federal
funds in behalf of, and transmit them to, applicants.
2. There is hereby established a nonreverting trust fund
designated as the Health Facilities Assistance Fund. Money received from
the Federal Government for a construction project approved by the federal
agency shall be transmitted to the State Treasurer to be deposited in the
State Treasury to the credit of the Health Facilities Assistance Fund,
and shall be used solely for payments due applicants for work performed,
purchases made or other approved expenditures in carrying out approved
projects or plans, except that any moneys in such Fund which become
available under the Federal Act and regulations for expenditure in
administering an approved state plan may be expended for that purpose.
3. The State Department shall establish and maintain such accounts
and fiscal controls of moneys deposited in and disbursed from the Health
Facilities Assistance Fund as may be required by the Federal Act and
regulations promulgated thereunder.
[17:219:1949; 1943 NCL § 5285.17]—(NRS A 1965, 988; 1975, 259)
1. In order to provide state assistance for construction projects
for publicly owned general hospitals, hospitals for the chronically ill
and impaired, facilities for the mentally retarded, community mental
health facilities, diagnostic or diagnostic and treatment centers,
rehabilitation facilities, nursing homes and other facilities financed in
part by federal funds in accordance with NRS 449.250 to 449.430 ,
inclusive, and to promote maximum utilization of federal funds available
for such projects, there is hereby created in the State Treasury a
nonreverting trust fund to be known as the State Public Health Facilities
Construction Assistance Fund. Money for the Fund may be provided from
time to time by legislative appropriation.
2. The State Public Health Facilities Construction Assistance Fund
must be administered by the State Department in accordance with the
purposes and provisions of NRS 449.250
to 449.430 , inclusive.
[17.1:219:1949; added 1956, 47]—(NRS A 1965, 989; 1985, 1744)
1. Money in the State Public Health Facilities Construction
Assistance Fund must be used to supplement money from the Federal
Government and money provided by the sponsor of a project for approved
projects for the construction of publicly owned general hospitals,
hospitals for the chronically ill or impaired, facilities for the
mentally retarded, community mental health facilities, diagnostic or
diagnostic and treatment centers, rehabilitation facilities, nursing
homes and other facilities financed in part by federal funds pursuant to
NRS 449.250 to 449.430 , inclusive, and for no other purpose or
purposes.
2. Applications for state assistance for construction projects
must be submitted to the State Department for consideration in the manner
prescribed in NRS 449.250 to 449.430
, inclusive, for applications for
federal assistance.
3. No project is entitled to receive state assistance unless it is
entitled to receive federal assistance.
[17.2:219:1949; added 1956, 47]—(NRS A 1965, 989; 1985, 1744)
Money in the State Public Health Facilities Construction Assistance Fund
must be allocated and paid to construction projects on the basis of
relative need in accordance with the need identified in the state health
plan and in accordance with a ratio between state money and federal money
determined by the State Department. In no event may the amount of state
assistance made available or paid out for a project exceed the amount
supplied by the sponsor of the project.
[17.3:219:1949; added 1956, 47]—(NRS A 1965, 989; 1981, 856, 1901)
Moneys in the State Public
Health Facilities Construction Assistance Fund allocated to a particular
approved project shall be paid out in installments at the same times and
in the same manner as installments of federal funds are paid out from the
Health Facilities Assistance Fund pursuant to NRS 449.390 .
[17.4:219:1949; added 1956, 47]—(NRS A 1965, 990)
ACCOUNTING; FINANCIAL REPORTS; FEES; ENSURING QUALITY OF CARE
As used in NRS 449.450 to 449.530 ,
inclusive, unless the context otherwise requires:
1. “Admitted health insurer” means an insurer authorized to
transact health insurance in this State under a certificate of authority
issued by the Commissioner of Insurance.
2. “Department” means the Department of Health and Human Services.
3. “Director” means the Director of the Department.
4. “Institution” means any person, place, building or agency which
maintains and operates facilities for the diagnosis, care and treatment
of human illness and provides beds for inpatient care. The term includes
but is not limited to hospitals, convalescent care facilities, nursing
care facilities, detoxification centers and all specialized medical
health care facilities.
(Added to NRS by 1975, 702; A 1979, 887; 1983, 1127; 1985, 1362;
1989, 1800; 1991, 2114)
The Director may:
1. Adopt regulations respecting the exercise of the powers
conferred by NRS 449.450 to 449.530
, inclusive.
2. Hold public hearings, conduct investigations and require the
filing of information relating to any matter affecting the cost of
services in all institutions subject to the provisions of NRS 449.450
to 449.530 , inclusive, and may subpoena witnesses,
financial papers, records and documents in connection therewith. An order
requiring the filing of information or a subpoena issued pursuant to this
subsection must state the purpose for which it is issued. The Director
may also administer oaths in any hearing or investigation.
3. Exercise, subject to the limitations and restrictions imposed
in NRS 449.450 to 449.530 , inclusive, all other powers which are
reasonably necessary to carry out the expressed objects of those sections.
4. Delegate to any of the divisions of the Department the
authority to carry out the provisions of NRS 449.450 to 449.530 ,
inclusive.
(Added to NRS by 1975, 702; A 1985, 1363; 1991, 2114; 1997, 2527)
1. The Director may, by regulation, impose fees upon admitted
health insurers to cover the costs of carrying out the provisions of NRS
449.450 to 449.530 , inclusive. The maximum amount of fees
collected must not exceed the amount authorized by the Legislature in
each biennial budget.
2. The Director shall impose a fee of $50 each year upon admitted
health insurers for the support of the Legislative Committee on Health
Care. The fee imposed pursuant to this subsection is in addition to any
fee imposed pursuant to subsection 1. The fee collected for the support
of the Legislative Committee on Health Care must be deposited in the
Legislative Fund.
(Added to NRS by 1983, 1126; A 1985, 1363; 1987, 877)
In
carrying out the duties prescribed by NRS 449.450 to 449.530 ,
inclusive, the Director may utilize his own staff or may contract with
any appropriate, independent and qualified organization. Such a
contractor shall not release or publish or otherwise use any information
made available to it under its contractual responsibility unless
permission is specifically granted by the Director.
(Added to NRS by 1975, 703; A 1985, 1363)
1. Each hospital licensed to operate in this state shall form a
committee to ensure the quality of care provided by the hospital. The
committee must be composed of, but is not limited to, physicians and
nurses.
2. Each committee formed pursuant to subsection 1 must meet the
requirements for programs or plans for ensuring the quality of care
specified by the Joint Commission on Accreditation of Healthcare
Organizations or by the Federal Government pursuant to Title XIX of the
Social Security Act (42 U.S.C. §§ 1396 et seq.).
(Added to NRS by 1989, 1799)
1. Each hospital in this State shall use for all patients
discharged the form commonly referred to as the “UB-82,” or a different
form prescribed by the Director with the approval of a majority of the
hospitals licensed in this State, and shall include in the form all
information required by the Department.
2. The Department shall by regulation:
(a) Specify the information required to be included in the form for
each patient; and
(b) Require each hospital to provide specified information from the
form to the Department.
3. Each insurance company or other payer shall accept the form as
the bill for services provided by hospitals in this State.
4. Except as otherwise provided in subsection 5, each hospital
with 100 or more beds shall provide the information required pursuant to
paragraph (b) of subsection 2 on magnetic tape or by other means
specified by the Department, or shall provide copies of the forms and pay
the costs of entering the information manually from the copies.
5. The Director may exempt a hospital from the requirements of
subsection 4 if requiring the hospital to comply with the requirements
would cause the hospital financial hardship.
(Added to NRS by 1987, 875; A 2005, 1736 )
1. Every institution which is subject to the provisions of NRS
449.450 to 449.530 , inclusive, shall file with the Department the
following financial statements or reports in a form and at intervals
specified by the Director but at least annually:
(a) A balance sheet detailing the assets, liabilities and net worth
of the institution for its fiscal year; and
(b) A statement of income and expenses for the fiscal year.
2. Each hospital with 100 or more beds shall file with the
Department, in a form and at intervals specified by the Director but at
least annually, a capital improvement report which includes, without
limitation, any major service line that the hospital has added or is in
the process of adding since the previous report was filed, any major
expansion of the existing facilities of the hospital that has been
completed or is in the process of being completed since the previous
report was filed, and any major piece of equipment that the hospital has
acquired or is in the process of acquiring since the previous report was
filed.
3. In addition to the information required to be filed pursuant to
subsections 1 and 2, each hospital with 100 or more beds shall file with
the Department, in a form and at intervals specified by the Director but
at least annually:
(a) The corporate home office allocation methodology of the
hospital, if any.
(b) The expenses that the hospital has incurred for providing
community benefits and the in-kind services that the hospital has
provided to the community in which it is located. For the purposes of
this paragraph, “community benefits” includes, without limitation, goods,
services and resources provided by a hospital to a community to address
the specific needs and concerns of that community, services provided by a
hospital to the uninsured and underserved persons in that community,
training programs for employees in a community and health care services
provided in areas of a community that have a critical shortage of such
services, for which the hospital does not receive full reimbursement.
(c) A statement of its policies and procedures for providing
discounted services to, or reducing charges for services provided to,
persons without health insurance that are in addition to any reduction or
discount required to be provided pursuant to NRS 439B.260 .
(d) A statement of its policies regarding patients’ account
receivables, including, without limitation, the manner in which a
hospital collects or makes payment arrangements for patients’ account
receivables, the factors that initiate collections and the method by
which unpaid account receivables are collected.
4. A complete current charge master must be available at each
hospital during normal business hours for review by the Director, any
payor that has a contract with the hospital to pay for services provided
by the hospital, any payor that has received a bill from the hospital and
any state agency that is authorized to review such information.
5. The Director shall require the certification of specified
financial reports by an independent certified public accountant and may
require attestations from responsible officers of the institution that
the reports are, to the best of their knowledge and belief, accurate and
complete to the extent that the certifications and attestations are not
required by federal law.
6. The Director shall require the filing of all reports by
specified dates, and may adopt regulations which assess penalties for
failure to file as required, but he shall not require the submission of a
final annual report sooner than 6 months after the close of the fiscal
year, and may grant extensions to institutions which can show that the
required information is not available on the required reporting date.
7. All reports, except privileged medical information, filed under
any provisions of NRS 449.450 to
449.530 , inclusive, are open to public
inspection and must be available for examination at the office of the
Department during regular business hours.
(Added to NRS by 1975, 702; A 1985, 1364; 1987, 877; 2005, 1737
)
The Director shall engage in or carry out analyses
and studies relating to the cost of health care in Nevada and other
states, the financial status of any institution subject to the provisions
of NRS 449.450 to 449.530 , inclusive, and any other appropriate related
matters, and he may publish and disseminate any information relating to
the financial aspects of health care as he deems desirable in the public
interest and in accordance with the provisions of NRS 449.450 to 449.530 ,
inclusive. He shall further require the filing of information concerning
the total financial needs of each institution and the resources available
or expected to become available to meet such needs, including but not
limited to the effect of proposals made by comprehensive areawide and
state health planning agencies. The information must be divided into at
least the following components of an institution’s expenses:
1. Operating expenses related to patient care.
2. Expenses incurred for rendering services to patients for whom
payment is not made in full including, but not limited to, the separate
expenses for contractual allowances imposed by federal or state law,
charity care and uncollectible accounts.
3. All incurred interest charges on indebtedness for both capital
and operating needs.
4. Costs of education, both primary and continuing.
5. Expenses for research related to patient care.
6. Depreciation expenses of both property and equipment.
7. Amortization of incurred capital and operating related
indebtedness.
8. Requirements for capital expenditures for replacement,
modernization, renovation and expansion of services and facilities.
9. Requirements for necessary working capital, including but not
limited to operating cash, patients’ accounts receivable and inventories.
10. Federal, state and local taxes not ordinarily considered
operating expenses where applicable.
11. Operating surpluses necessary for a fair return to their
owners equal to returns on investments in industries of comparable risk,
or for the purpose of assuring continuity of operation and prudent
management.
(Added to NRS by 1975, 703; A 1985, 1364)
1. The Director shall prepare and file such summaries,
compilations or other supplementary reports based on the information
filed with him pursuant to NRS 449.450
to 449.530 , inclusive, as will advance
the purposes of those sections. All such summaries, compilations and
reports are open to public inspection, must be made available to
requesting agencies and must be prepared within a reasonable time
following the end of each institution’s fiscal year or more frequently as
specified by the Director.
2. The Director shall not collect, maintain, disclose, report or
publish the details of contracts entered into by a hospital, or collect,
maintain, disclose, report or publish information pursuant to this
section in a manner that would allow identification of an individual
payer or other party to a contract with the hospital, except that the
Director may disclose to other state agencies the details of contracts
between the hospital and a related entity. A state agency shall not
collect, maintain, disclose, report or publish information disclosed to
the agency by the Director pursuant to this subsection in a manner that
would allow identification of an individual payer or other party to a
contract with the hospital. The Director may review any such contracts at
the hospital or at a location specified by the hospital.
3. As used in this section, “related entity” means an affiliated
person or subsidiary as those terms are defined in NRS 439B.430 .
(Added to NRS by 1975, 704; A 1985, 1365; 1991, 2333; 1993, 619;
1997, 2527)
1. On or before October 1 of each year, the Director shall prepare
and transmit to the Governor, the Legislative Committee on Health Care
and the Interim Finance Committee a report of the Department’s operations
and activities for the preceding fiscal year.
2. The report prepared pursuant to subsection 1 must include:
(a) Copies of all summaries, compilations and supplementary reports
required by NRS 449.450 to 449.530
, inclusive, together with such facts,
suggestions and policy recommendations as the Director deems necessary;
(b) A summary of the trends of the audits of hospitals in this
State that the Department required or performed during the previous year;
(c) An analysis of the trends in the costs, expenses and profits of
hospitals in this State;
(d) An analysis of the corporate home office allocation
methodologies of hospitals in this State;
(e) An examination and analysis of the manner in which hospitals
are reporting the information that is required to be filed pursuant to
NRS 449.490 , including, without
limitation, an examination and analysis of whether that information is
being reported in a standard and consistent manner, which fairly reflect
the operations of each hospital;
(f) A review and comparison of the policies and procedures used by
hospitals in this State to provide discounted services to, and to reduce
charges for services provided to, persons without health insurance; and
(g) A review and comparison of the policies and procedures used by
hospitals in this State to collect unpaid charges for services provided
by the hospitals.
3. The Legislative Committee on Health Care shall develop a
comprehensive plan concerning the provision of health care in this State
which includes, without limitation:
(a) A review of the health care needs in this State as identified
by state agencies, local governments, providers of health care and the
general public; and
(b) A review of the capital improvement reports submitted by
hospitals pursuant to subsection 2 of NRS 449.490 .
(Added to NRS by 1975, 704; A 1983, 1127; 1985, 1365; 2005, 1738
)
The Director may
impose upon the institutions subject to supervision under NRS 449.450
to 449.530 , inclusive, an administrative fine not
exceeding $500 per day for each violation of any of the provisions of NRS
449.450 to 449.530 , inclusive.
(Added to NRS by 1975, 704; A 1985, 1365)
WITHHOLDING OR WITHDRAWAL OF LIFE-SUSTAINING TREATMENT
1. NRS 449.535 to 449.690 , inclusive, may be cited as the Uniform Act on
Rights of the Terminally Ill.
2. NRS 449.535 to 449.690 , inclusive, must be applied and construed to
effectuate its general purpose to make uniform the law with respect to
the subject of those sections among states enacting the Uniform Act on
Rights of the Terminally Ill.
(Added to NRS by 1991, 629)
As used in NRS 449.535 to 449.690 ,
inclusive, unless the context otherwise requires, the words and terms
defined in NRS 449.550 to 449.590
, inclusive, have the meanings ascribed
to them in those sections.
(Added to NRS by 1977, 759; A 1991, 632)
“Attending physician”
means the physician who has primary responsibility for the treatment and
care of the patient.
(Added to NRS by 1977, 759; A 1991, 632)
“Declaration” means a writing
executed in accordance with the requirements of NRS 449.600 .
(Added to NRS by 1977, 759; A 1991, 632)
“Life-sustaining
treatment” means a medical procedure or intervention that, when
administered to a patient, serves only to prolong the process of dying.
(Added to NRS by 1977, 759; A 1991, 633)
“Person” includes a government or a
governmental subdivision or agency.
(Added to NRS by 1991, 629)
“Provider of
health care” means a person who is licensed, certified or otherwise
authorized by the law of this state to administer health care in the
ordinary course of business or practice of a profession.
(Added to NRS by 1991, 629)
“Qualified patient”
means a patient 18 or more years of age who has executed a declaration
and who has been determined by the attending physician to be in a
terminal condition.
(Added to NRS by 1991, 629)
“Terminal condition”
means an incurable and irreversible condition that, without the
administration of life-sustaining treatment, will, in the opinion of the
attending physician, result in death within a relatively short time.
(Added to NRS by 1977, 759; A 1991, 633)
1. A person of sound mind and 18 or more years of age may execute
at any time a declaration governing the withholding or withdrawal of
life-sustaining treatment. The declarant may designate another natural
person of sound mind and 18 or more years of age to make decisions
governing the withholding or withdrawal of life-sustaining treatment. The
declaration must be signed by the declarant, or another at the
declarant’s direction, and attested by two witnesses.
2. A physician or other provider of health care who is furnished a
copy of the declaration shall make it a part of the declarant’s medical
record and, if unwilling to comply with the declaration, promptly so
advise the declarant and any person designated to act for the declarant.
(Added to NRS by 1977, 759; A 1985, 1747; 1991, 633)
A declaration directing a physician
to withhold or withdraw life-sustaining treatment may, but need not, be
in the following form:
DECLARATION
If I should have an incurable and irreversible condition that, without
the administration of life-sustaining treatment, will, in the opinion of
my attending physician, cause my death within a relatively short time,
and I am no longer able to make decisions regarding my medical treatment,
I direct my attending physician, pursuant to NRS 449.535 to 449.690 ,
inclusive, to withhold or withdraw treatment that only prolongs the
process of dying and is not necessary for my comfort or to alleviate pain.
If you wish to include this statement in this declaration, you must
INITIAL the statement in the box provided:
Withholding or withdrawal of artificial nutrition and hydration may
result in death by starvation or dehydration. Initial this box if you
want to receive or continue receiving artificial nutrition and hydration
by way of the gastrointestinal tract after all other treatment is
withheld pursuant to this declaration.
[............................................ ]
Signed this ........………...... day of ..…..........., ......
Signature..........................................................
Address............................................................
The declarant voluntarily signed this writing in my presence.
Witness............................................................
Address............................................................
Witness............................................................
Address............................................................
(Added to NRS by 1977, 760; A 1991, 633; 1993, 2790)
1. A declaration that designates another person to make decisions
governing the withholding or withdrawal of life-sustaining treatment may,
but need not, be in the following form:
DECLARATION
If I should have an incurable and irreversible condition that, without
the administration of life-sustaining treatment, will, in the opinion of
my attending physician, cause my death within a relatively short time,
and I am no longer able to make decisions regarding my medical treatment,
I appoint ............................... or, if he or she is not
reasonably available or is unwilling to serve,
.............................., to make decisions on my behalf regarding
withholding or withdrawal of treatment that only prolongs the process of
dying and is not necessary for my comfort or to alleviate pain, pursuant
to NRS 449.535 to 449.690 , inclusive. (If the person or persons I have
so appointed are not reasonably available or are unwilling to serve, I
direct my attending physician, pursuant to those sections, to withhold or
withdraw treatment that only prolongs the process of dying and is not
necessary for my comfort or to alleviate pain.)
Strike language in parentheses if you do not desire it.
If you wish to include this statement in this declaration, you must
INITIAL the statement in the box provided:
Withholding or withdrawal of artificial nutrition and hydration may
result in death by starvation or dehydration. Initial this box if you
want to receive or continue receiving artificial nutrition and hydration
by way of the gastrointestinal tract after all other treatment is
withheld pursuant to this declaration.
[............................................ ]
Signed this ........………...... day of ..…..........., ......
Signature..........................................................
Address............................................................
The declarant voluntarily signed this writing in my presence.
Witness............................................................
Address............................................................
Witness............................................................
Address............................................................
Name and address of each designee.
Name.................................................................
Address............................................................
2. The designation of an attorney-in-fact pursuant to NRS 111.460
or 449.800 to 449.860 ,
inclusive, or the judicial appointment of a guardian, who is authorized
to make decisions regarding the withholding or withdrawal of
life-sustaining treatment, constitutes for the purpose of NRS 449.535
to 449.690 , inclusive, a declaration designating another
person to act for the declarant pursuant to subsection 1.
(Added to NRS by 1991, 630; A 1993, 2791)
A declaration becomes operative when it is communicated
to the attending physician and the declarant is determined by the
attending physician to be in a terminal condition and no longer able to
make decisions regarding administration of life-sustaining treatment.
When the declaration becomes operative, the attending physician and other
providers of health care shall act in accordance with its provisions and
with the instructions of a person designated pursuant to NRS 449.600
or comply with the requirements of NRS
449.628 to transfer care of the
declarant.
(Added to NRS by 1991, 631)
1. A declarant may revoke a declaration at any time and in any
manner, without regard to his mental or physical condition. A revocation
is effective upon its communication to the attending physician or other
provider of health care by the declarant or a witness to the revocation.
2. The attending physician or other provider of health care shall
make the revocation a part of the declarant’s medical record.
(Added to NRS by 1977, 760; A 1987, 1309; 1991, 635)
Upon determining that a declarant is in a terminal
condition, the attending physician who knows of a declaration shall
record the determination, and the terms of the declaration if not already
a part of the record, in the declarant’s medical record.
(Added to NRS by 1991, 631)
1. A qualified patient may make decisions regarding
life-sustaining treatment so long as he is able to do so.
2. NRS 449.535 to 449.690 , inclusive, do not affect the responsibility
of the attending physician or other provider of health care to provide
treatment for a patient’s comfort or alleviation of pain.
3. Artificial nutrition and hydration by way of the
gastrointestinal tract shall be deemed a life-sustaining treatment and
must be withheld or withdrawn from a qualified patient unless a different
desire is expressed in writing by the patient. For a patient who has no
effective declaration, artificial nutrition and hydration must not be
withheld unless a different desire is expressed in writing by his
authorized representative or the family member with the authority to
consent or withhold consent.
4. Life-sustaining treatment must not be withheld or withdrawn
pursuant to a declaration from a qualified patient known to the attending
physician to be pregnant so long as it is probable that the fetus will
develop to the point of live birth with continued application of
life-sustaining treatment.
(Added to NRS by 1991, 631)
1. If written consent to the withholding or withdrawal of the
treatment, attested by two witnesses, is given to the attending
physician, the attending physician may withhold or withdraw
life-sustaining treatment from a patient who:
(a) Has been determined by the attending physician to be in a
terminal condition and no longer able to make decisions regarding
administration of life-sustaining treatment; and
(b) Has no effective declaration.
2. The authority to consent or to withhold consent under
subsection 1 may be exercised by the following persons, in order of
priority:
(a) The spouse of the patient;
(b) An adult child of the patient or, if there is more than one
adult child, a majority of the adult children who are reasonably
available for consultation;
(c) The parents of the patient;
(d) An adult sibling of the patient or, if there is more than one
adult sibling, a majority of the adult siblings who are reasonably
available for consultation; or
(e) The nearest other adult relative of the patient by blood or
adoption who is reasonably available for consultation.
3. If a class entitled to decide whether to consent is not
reasonably available for consultation and competent to decide, or
declines to decide, the next class is authorized to decide, but an equal
division in a class does not authorize the next class to decide.
4. A decision to grant or withhold consent must be made in good
faith. A consent is not valid if it conflicts with the expressed
intention of the patient.
5. A decision of the attending physician acting in good faith that
a consent is valid or invalid is conclusive.
6. Life-sustaining treatment must not be withheld or withdrawn
pursuant to this section from a patient known to the attending physician
to be pregnant so long as it is probable that the fetus will develop to
the point of live birth with continued application of life-sustaining
treatment.
(Added to NRS by 1991, 631)
An attending physician
or other provider of health care who is unwilling to comply with NRS
449.535 to 449.690 , inclusive, shall take all reasonable steps as
promptly as practicable to transfer care of the declarant to another
physician or provider of health care.
(Added to NRS by 1991, 632)
1. A physician or other provider of health care is not subject to
civil or criminal liability, or discipline for unprofessional conduct,
for giving effect to a declaration or the direction of a person
designated pursuant to NRS 449.600 in
the absence of knowledge of the revocation of a declaration, or for
giving effect to a written consent under NRS 449.626 .
2. A physician or other provider of health care, whose action
pursuant to NRS 449.535 to 449.690
, inclusive, is in accord with
reasonable medical standards, is not subject to civil or criminal
liability, or discipline for unprofessional conduct, with respect to that
action.
3. A physician or other provider of health care, whose decision
about the validity of consent under NRS 449.626 is made in good faith, is not subject to civil
or criminal liability, or discipline for unprofessional conduct, with
respect to that decision.
4. A person designated pursuant to NRS 449.600 or a person authorized to consent pursuant to
NRS 449.626 , whose decision is made or
consent is given in good faith pursuant to NRS 449.535 to 449.690 ,
inclusive, is not subject to civil or criminal liability, or discipline
for unprofessional conduct, with respect to that decision.
(Added to NRS by 1977, 760; A 1985, 1747; 1991, 635)
1. If a patient in a terminal condition has a declaration in
effect and becomes comatose or is otherwise rendered incapable of
communicating with his attending physician, the physician must give
weight to the declaration as evidence of the patient’s directions
regarding the application of life-sustaining treatments, but the
attending physician may also consider other factors in determining
whether the circumstances warrant following the directions.
2. No hospital or other medical facility, physician or person
working under the direction of a physician is subject to criminal or
civil liability for failure to follow the directions of the patient to
withhold or withdraw life-sustaining treatments.
(Added to NRS by 1977, 761; A 1985, 1747; 1993, 2792)
1. Unless he has knowledge to the contrary, a physician or other
provider of health care may assume that a declaration complies with NRS
449.535 to 449.690 , inclusive, and is valid.
2. NRS 449.535 to 449.690 , inclusive, create no presumption concerning
the intention of a person who has revoked or has not executed a
declaration with respect to the use, withholding or withdrawal of
life-sustaining treatment in the event of a terminal condition.
(Added to NRS by 1991, 632)
1. Death resulting from the withholding or withdrawal of
life-sustaining treatment in accordance with NRS 449.535 to 449.690 ,
inclusive, does not constitute, for any purpose, a suicide or homicide.
2. The making of a declaration pursuant to NRS 449.600 does not affect the sale, procurement or
issuance of a policy of life insurance or annuity, nor does it affect,
impair or modify the terms of an existing policy of life insurance or
annuity. A policy of life insurance or annuity is not legally impaired or
invalidated by the withholding or withdrawal of life-sustaining treatment
from an insured, notwithstanding any term to the contrary.
3. A person may not prohibit or require the execution of a
declaration as a condition for being insured for, or receiving, health
care.
(Added to NRS by 1977, 761; A 1991, 636)
1. A physician or other provider of health care who willfully
fails to transfer the care of a patient in accordance with NRS 449.628
is guilty of a gross misdemeanor.
2. A physician who willfully fails to record a determination of
terminal condition or the terms of a declaration in accordance with NRS
449.622 is guilty of a misdemeanor.
3. A person who willfully conceals, cancels, defaces or
obliterates the declaration of another without the declarant’s consent or
who falsifies or forges a revocation of the declaration of another is
guilty of a misdemeanor.
4. A person who falsifies or forges the declaration of another, or
willfully conceals or withholds personal knowledge of a revocation, with
the intent to cause a withholding or withdrawal of life-sustaining
treatment contrary to the wishes of the declarant and thereby directly
causes life-sustaining treatment to be withheld or withdrawn and death to
be hastened is guilty of murder.
5. A person who requires or prohibits the execution of a
declaration as a condition of being insured for, or receiving, health
care is guilty of a misdemeanor.
6. A person who coerces or fraudulently induces another to execute
a declaration, or who falsifies or forges the declaration of another
except as provided in subsection 4, is guilty of a gross misdemeanor.
7. The penalties provided in this section do not displace any
sanction applicable under other law.
(Added to NRS by 1977, 761; A 1991, 636)
1. NRS 449.535 to 449.690 , inclusive, do not require a physician or
other provider of health care to take action contrary to reasonable
medical standards.
2. NRS 449.535 to 449.690 , inclusive, do not condone, authorize or
approve mercy-killing, assisted suicide or euthanasia.
(Added to NRS by 1977, 761; A 1991, 637; 1995, 1794)
NRS 449.535 to 449.690
, inclusive, do not affect the right of
a patient to make decisions regarding use of life-sustaining treatment,
so long as he is able to do so, or impair or supersede a right or
responsibility that any person has to effect the withholding or
withdrawal of medical care.
(Added to NRS by 1977, 761; A 1991, 637)
1. A declaration executed in another state in compliance with the
law of that state or of this State is valid for purposes of NRS 449.535
to 449.690 , inclusive.
2. An instrument executed anywhere before July 1, 1977, which
clearly expresses the intent of the declarant to direct the withholding
or withdrawal of life-sustaining treatment from him when he is in a
terminal condition and becomes comatose or is otherwise rendered
incapable of communicating with his attending physician, if executed in a
manner which attests voluntary execution, or executed anywhere before
October 1, 1991, which substantially complies with NRS 449.600 , and has not been subsequently revoked, is
effective under NRS 449.535 to 449.690
, inclusive.
3. As used in this section, “state” includes the District of
Columbia, the Commonwealth of Puerto Rico, and a territory or insular
possession subject to the jurisdiction of the United States.
(Added to NRS by 1977, 761; A 1991, 637)
PATIENT’S RIGHTS
1. Every medical facility, facility for the dependent and home for
individual residential care must provide the services necessary to treat
properly a patient in a particular case or must be able to arrange the
transfer of the patient to another facility or home which can provide
that care.
2. A patient may be transferred to another facility or home only
if the patient has received an explanation of the need to transfer him
and the alternatives available, unless his condition necessitates an
immediate transfer to a facility for a higher level of care and he is
unable to understand the explanation.
(Added to NRS by 1983, 820; A 1985, 1747; 1999, 1051 )
1. If a patient in a medical facility or facility for the
dependent is transferred to another medical facility or facility for the
dependent, a division facility or a physician licensed to practice
medicine, the facility shall forward a copy of the medical records of the
patient, on or before the date the patient is transferred, to the other
medical facility or facility for the dependent, the division facility or
the physician. The facility is not required to obtain the oral or written
consent of the patient to forward a copy of the medical records.
2. If a person receiving services in a home for individual
residential care is transferred to another home, the home shall forward a
copy of his medical records to the other home in the manner provided in
subsection 1.
3. As used in this section:
(a) “Division facility” means any unit or subunit operated by a
division of the Department of Health and Human Services pursuant to title
39 of NRS.
(b) “Medical records” includes a medical history of the patient, a
summary of the current physical condition of the patient and a discharge
summary which contains the information necessary for the proper treatment
of the patient.
(Added to NRS by 1991, 2349; A 1993, 2725; 1999, 1051 )
Every patient of a medical facility,
facility for the dependent or home for individual residential care has
the right to:
1. Receive information concerning any other medical or educational
facility or facility for the dependent associated with the facility at
which he is a patient which relates to his care.
2. Obtain information concerning the professional qualifications
or associations of the persons who are treating him.
3. Receive the name of the person responsible for coordinating his
care in the facility or home.
4. Be advised if the facility in which he is a patient proposes to
perform experiments on patients which affect his own care or treatment.
5. Receive from his physician a complete and current description
of his diagnosis, plan for treatment and prognosis in terms which he is
able to understand. If it is not medically advisable to give this
information to the patient, the physician shall:
(a) Provide the information to an appropriate person responsible
for the patient; and
(b) Inform that person that he shall not disclose the information
to the patient.
6. Receive from his physician the information necessary for him to
give his informed consent to a procedure or treatment. Except in an
emergency, this information must not be limited to a specific procedure
or treatment and must include:
(a) A description of the significant medical risks involved;
(b) Any information on alternatives to the treatment or procedure
if he requests that information;
(c) The name of the person responsible for the procedure or
treatment; and
(d) The costs likely to be incurred for the treatment or procedure
and any alternative treatment or procedure.
7. Examine the bill for his care and receive an explanation of the
bill, whether or not he is personally responsible for payment of the bill.
8. Know the regulations of the facility or home concerning his
conduct at the facility or home.
9. Receive, within reasonable restrictions as to time and place,
visitors of his choosing, including, without limitation, friends and
members of his family.
(Added to NRS by 1983, 820; A 1985, 906, 1748; 1999, 1052 ; 2001, 3047 )
1. If, as a result of the incapacitation of the patient or his
inability to communicate, a patient of a medical facility, facility for
the dependent or home for individual residential care who is 18 years of
age or older is unable to inform the staff of the facility or home of the
persons whom the patient authorizes to visit the patient at the facility
or home, the facility or home shall allow visitation rights to any person
designated by the patient in a letter, form or other document authorizing
visitation executed in accordance with subsection 2. The visitation
rights required by this subsection must be:
(a) Provided in accordance with the visitation policies of the
facility or home; and
(b) The same visitation rights that are provided to a member of the
patient’s family who is legally related to the patient.
2. A person 18 years of age or older wishing to designate a person
for the purposes of establishing visitation rights in a medical facility,
facility for the dependent or home for individual residential care may
execute a letter, form or other document authorizing visitation in
substantially the following form:
(Date)..................................
I, ..............................., (patient who is designating
another person as having visitation rights of the patient) do hereby
designate .................................. (person who is being
designated as having visitation rights of the patient) as having the
right to visit me in a medical facility, facility for the dependent or
home for individual residential care. I hereby instruct all staff of a
medical facility, facility for the dependent or home for individual
residential care in which I am a patient to admit
...................................... (person who is being designated as
having visitation rights of the patient) to my room and afford him or her
the same visitation rights as are provided to members of my family who
are legally related to me during my time as a patient.
........................................................
(Signed)
(Added to NRS by 2003, 1879 )
Every patient of a medical facility, facility for the dependent or home
for individual residential care has the right to:
1. Receive considerate and respectful care.
2. Refuse treatment to the extent permitted by law and to be
informed of the consequences of that refusal.
3. Refuse to participate in any medical experiments conducted at
the facility.
4. Retain his privacy concerning his program of medical care.
Discussions of a patient’s care, consultation with other persons
concerning the patient, examinations or treatments, and all
communications and records concerning the patient, except as otherwise
provided in NRS 108.640 , 442.300 to 442.330 ,
inclusive, and 449.705 , and chapter 629
of NRS, are confidential. The patient must
consent to the presence of any person who is not directly involved with
his care during any examination, consultation or treatment.
5. Have any reasonable request for services reasonably satisfied
by the facility or home considering its ability to do so.
6. Receive continuous care from the facility or home. The patient
must be informed:
(a) Of his appointments for treatment and the names of the persons
available at the facility or home for those treatments; and
(b) By his physician or an authorized representative of the
physician, of his need for continuing care.
(Added to NRS by 1983, 821; A 1985, 1748; 1989, 2057; 1991, 2350;
1999, 1052 , 3512 )
1. Every medical facility, facility for the dependent and home for
individual residential care shall inform each patient or his legal
representative, upon his admission to the facility or home, of the
patient’s rights as listed in NRS 449.700 , 449.710 ,
449.715 and 449.720 .
2. In addition to the requirements of subsection 1, if a person
with a disability is a patient at a facility, as that term is defined in
NRS 449.771 , the facility shall inform
the patient of his rights pursuant to NRS 449.765 to 449.786 ,
inclusive.
3. In addition to the requirements of subsections 1 and 2, every
hospital shall, upon the admission of a patient to the hospital, provide
to the patient or his legal representative a written disclosure approved
by the Director, which written disclosure must set forth:
(a) Notice of the existence of the Bureau for Hospital Patients
created pursuant to NRS 223.575 ;
(b) The address and telephone number of the Bureau; and
(c) An explanation of the services provided by the Bureau,
including, without limitation, the services for dispute resolution
described in subsection 3 of NRS 223.575 .
4. In addition to the requirements of subsections 1, 2 and 3,
every hospital shall, upon the discharge of a patient from the hospital,
provide to the patient or his legal representative a written disclosure
approved by the Director, which written disclosure must set forth:
(a) If the hospital is a major hospital:
(1) Notice of the reduction or discount available pursuant
to NRS 439B.260 , including, without
limitation, notice of the criteria a patient must satisfy to qualify for
a reduction or discount under that section; and
(2) Notice of any policies and procedures the hospital may
have adopted to reduce charges for services provided to persons or to
provide discounted services to persons, which policies and procedures are
in addition to any reduction or discount required to be provided pursuant
to NRS 439B.260 . The notice required
by this subparagraph must describe the criteria a patient must satisfy to
qualify for the additional reduction or discount, including, without
limitation, any relevant limitations on income and any relevant
requirements as to the period within which the patient must arrange to
make payment.
(b) If the hospital is not a major hospital, notice of any policies
and procedures the hospital may have adopted to reduce charges for
services provided to persons or to provide discounted services to
persons. The notice required by this paragraph must describe the criteria
a patient must satisfy to qualify for the reduction or discount,
including, without limitation, any relevant limitations on income and any
relevant requirements as to the period within which the patient must
arrange to make payment.
Ê As used in this subsection, “major hospital” has the meaning ascribed
to it in NRS 439B.115 .
5. In addition to the requirements of subsections 1 to 4,
inclusive, every hospital shall post in a conspicuous place in each
public waiting room in the hospital a legible sign or notice in 14-point
type or larger, which sign or notice must:
(a) Provide a brief description of any policies and procedures the
hospital may have adopted to reduce charges for services provided to
persons or to provide discounted services to persons, including, without
limitation:
(1) Instructions for receiving additional information
regarding such policies and procedures; and
(2) Instructions for arranging to make payment;
(b) Be written in language that is easy to understand; and
(c) Be written in English and Spanish.
(Added to NRS by 1983, 822; A 1985, 1749; 1999, 1053 , 3252 ; 2003, 1880 ; 2005, 947 )
1. A physician shall not perform any procedure to insert an
implant in the breast of a patient unless within 5 days before the
procedure is performed he has:
(a) Discussed with the patient and any other person whose consent
is required pursuant to paragraph (b), the advantages, disadvantages and
risks associated with the procedure; and
(b) Obtained informed consent in writing from the following persons
freely and without coercion:
(1) The patient if he is 18 years of age or over or legally
emancipated and competent to give that consent, and from his legal
guardian, if any;
(2) The parent or guardian of a patient under 18 years of
age and not legally emancipated; or
(3) The legal guardian of a patient of any age who has been
adjudicated mentally incompetent,
Ê and the required consent was not withdrawn pursuant to subsection 3
before the procedure began.
2. An informed consent requires that the person whose consent is
sought be adequately informed as to:
(a) The nature and consequences of the procedure;
(b) The reasonable risks, possible side effects, benefits and
purposes of the procedure; and
(c) Any alternative procedures available.
3. The consent of a patient or other person whose consent is
required pursuant to paragraph (b) of subsection 1 may be withdrawn in
writing at any time before the procedure has begun, with or without cause.
4. A physician satisfies the requirements of:
(a) Paragraph (a) of subsection 1 if he provides the patient and
any other person whose consent is required pursuant to paragraph (b) of
subsection 1 with a copy of the current explanation form prepared by the
Health Division pursuant to NRS 449.750
in a language that the person is able to read.
(b) Paragraph (b) of subsection 1 if the person or persons whose
consent is required sign a copy of the current consent form prepared by
the Health Division pursuant to NRS 449.750 freely and without coercion and the consent is
not withdrawn pursuant to subsection 3 before the procedure has begun.
The consent form must be in a language that the person who signs the form
is able to read.
5. Any person who violates the provisions of this section is
guilty of a misdemeanor.
(Added to NRS by 1991, 1690)
1. The Health Division shall prepare and provide to physicians
upon request:
(a) An explanation form for a procedure to insert an implant in the
breast of a person which includes:
(1) An explanation of the advantages, disadvantages and
risks associated with a procedure to insert an implant in the breast of a
person, including any known side effects; and
(2) Any other information the Health Division determines to
be useful to a person contemplating a procedure to insert an implant in
the breast; and
(b) A consent form for a procedure to insert an implant in the
breast of a person which includes:
(1) The nature and consequences of the procedure;
(2) The reasonable risks, possible side effects, benefits
and purposes of the procedure; and
(3) Any alternative procedures available.
2. The Health Division shall revise the explanation form and
consent form as necessary to keep the medical information current.
3. The Health Division shall charge and collect a fee for all
forms distributed pursuant to this section that is adequate to cover the
cost of producing the forms.
(Added to NRS by 1991, 1690)
PREVENTING PERSONS FROM ENTERING OR EXITING HEALTH FACILITY
1. Except as otherwise provided in this section, a person shall
not intentionally prevent another person from entering or exiting the
office of a physician, a health facility, a nonprofit health facility, a
public health center, a medical facility or a facility for the dependent
by physically:
(a) Detaining the other person; or
(b) Obstructing, impeding or hindering the other person’s movement.
2. The provisions of subsection 1 are inapplicable to:
(a) An officer, employee or agent of the physician, health
facility, nonprofit health facility, public health center, medical
facility or facility for the dependent; or
(b) A peace officer as defined in NRS 169.125 ,
Ê while acting within the course and scope of his duties or employment.
3. The provisions of subsection 1 do not prohibit a person from
maintaining a picket during a strike or work stoppage in compliance with
the provisions of NRS 614.160 , or from
engaging in any constitutionally protected exercise of free speech.
4. A person who violates the provisions of subsection 1 is guilty
of a misdemeanor and shall be punished by a fine of not more than $1,000,
or by imprisonment in the county jail for not more than 3 months, or by
both fine and imprisonment.
5. As used in this section, the terms “health facility,”
“nonprofit health facility” and “public health center” have the meanings
ascribed to them in NRS 449.260 .
(Added to NRS by 1991, 1687)
USE OF AVERSIVE INTERVENTION OR FORMS OF RESTRAINT ON PATIENTS WITH
DISABILITIES
As used in NRS 449.765 to 449.786 ,
inclusive, unless the context otherwise requires, the words and terms
defined in NRS 449.766 to 449.775
, inclusive, have the meanings ascribed
to them in those sections.
(Added to NRS by 1999, 3247 )
“Aversive
intervention” means any of the following actions if the action is used to
punish a person with a disability or to eliminate, reduce or discourage
maladaptive behavior of a person with a disability:
1. The use of noxious odors and tastes;
2. The use of water and other mists or sprays;
3. The use of blasts of air;
4. The use of corporal punishment;
5. The use of verbal and mental abuse;
6. The use of electric shock;
7. Requiring a person to perform exercise under forced conditions
if the:
(a) Person is required to perform the exercise because he exhibited
a behavior that is related to his disability;
(b) Exercise is harmful to the health of the person because of his
disability; or
(c) Nature of the person’s disability prevents him from engaging in
the exercise;
8. Any intervention, technique or procedure that deprives a person
of the use of one or more of his senses, regardless of the length of the
deprivation, including, without limitation, the use of sensory screens; or
9. The deprivation of necessities needed to sustain the health of
a person, regardless of the length of the deprivation, including, without
limitation, the denial or unreasonable delay in the provision of:
(a) Food or liquid at a time when it is customarily served; or
(b) Medication.
Ê The term does not include the withholding or withdrawal of
life-sustaining treatment in accordance with NRS 449.626 .
(Added to NRS by 1999, 3247 )
“Chemical restraint”
means the administration of drugs for the specific and exclusive purpose
of controlling an acute or episodic aggressive behavior when alternative
intervention techniques have failed to limit or control the behavior. The
term does not include the administration of drugs on a regular basis, as
prescribed by a physician, to treat the symptoms of mental, physical,
emotional or behavioral disorders and for assisting a person in gaining
self-control over his impulses.
(Added to NRS by 1999, 3247 )
“Corporal punishment”
means the intentional infliction of physical pain, including, without
limitation, hitting, pinching or striking.
(Added to NRS by 1999, 3248 )
“Electric shock” means the
application of electric current to a person’s skin or body. The term does
not include electroconvulsive therapy.
(Added to NRS by 1999, 3248 )
“Emergency” means a situation in
which immediate intervention is necessary to protect the physical safety
of a person or others from an immediate threat of physical injury or to
protect against an immediate threat of severe property damage.
(Added to NRS by 1999, 3248 )
“Facility” means a facility
licensed pursuant to this chapter that is a psychiatric hospital or a
unit of a hospital that is specifically designated to provide care and
services to persons with psychiatric or developmental disabilities.
(Added to NRS by 1999, 3248 )
“Mechanical
restraint” means the use of devices, including, without limitation,
mittens, straps and restraint chairs to limit a person’s movement or hold
a person immobile.
(Added to NRS by 1999, 3248 )
“Person with a
disability” means a person who:
1. Has a physical or mental impairment that substantially limits
one or more of the major life activities of the person;
2. Has a record of such an impairment; or
3. Is regarded as having such an impairment.
(Added to NRS by 1999, 3248 )
“Physical restraint”
means the use of physical contact to limit a person’s movement or hold a
person immobile.
(Added to NRS by 1999, 3248 )
“Verbal and mental
abuse” means actions or utterances that are intended to cause and
actually cause severe emotional distress to a person.
(Added to NRS by 1999, 3248 )
A person
employed by a facility licensed pursuant to this chapter or any other
person shall not use any aversive intervention on a person with a
disability who is a patient at the facility.
(Added to NRS by 1999, 3248 )
A person
employed by a facility licensed pursuant to this chapter or any other
person shall not:
1. Except as otherwise provided in NRS 449.778 , use physical restraint on a person with a
disability who is a patient at the facility.
2. Except as otherwise provided in NRS 449.779 , use mechanical restraint on a person with a
disability who is a patient at the facility.
3. Except as otherwise provided in NRS 449.780 , use chemical restraint on a person with a
disability who is a patient at the facility.
(Added to NRS by 1999, 3248 )
1. Except as otherwise provided in subsection 2, physical
restraint may be used on a person with a disability who is a patient at a
facility only if:
(a) An emergency exists that necessitates the use of physical
restraint;
(b) The physical restraint is used only for the period that is
necessary to contain the behavior of the patient so that the patient is
no longer an immediate threat of causing physical injury to himself or
others or causing severe property damage; and
(c) The use of force in the application of physical restraint does
not exceed the force that is reasonable and necessary under the
circumstances precipitating the use of physical restraint.
2. Physical restraint may be used on a person with a disability
who is a patient at a facility and the provisions of subsection 1 do not
apply if the physical restraint is used to:
(a) Assist the patient in completing a task or response if the
patient does not resist the application of physical restraint or if his
resistance is minimal in intensity and duration;
(b) Escort or carry a patient to safety if the patient is in danger
in his present location; or
(c) Conduct medical examinations or treatments on the patient that
are necessary.
3. If physical restraint is used on a person with a disability who
is a patient at a facility in an emergency, the use of the procedure must
be reported as a denial of rights pursuant to NRS 449.786 , regardless of whether the use of the
procedure is authorized by statute. The report must be made not later
than 1 working day after the procedure is used.
(Added to NRS by 1999, 3249 )
1. Except as otherwise provided in subsection 2, mechanical
restraint may be used on a person with a disability who is a patient at a
facility only if:
(a) An emergency exists that necessitates the use of mechanical
restraint;
(b) A medical order authorizing the use of mechanical restraint is
obtained from the patient’s treating physician before the application of
the mechanical restraint or not later than 15 minutes after the
application of the mechanical restraint;
(c) The physician who signed the order required pursuant to
paragraph (b) or the attending physician examines the patient not later
than 1 working day immediately after the application of the mechanical
restraint;
(d) The mechanical restraint is applied by a member of the staff of
the facility who is trained and qualified to apply mechanical restraint;
(e) The patient is given the opportunity to move and exercise the
parts of his body that are restrained at least 10 minutes per every 60
minutes of restraint;
(f) A member of the staff of the facility lessens or discontinues
the restraint every 15 minutes to determine whether the patient will stop
or control his inappropriate behavior without the use of the restraint;
(g) The record of the patient contains a notation that includes the
time of day that the restraint was lessened or discontinued pursuant to
paragraph (f), the response of the patient and the response of the member
of the staff of the facility who applied the mechanical restraint;
(h) A member of the staff of the facility continuously monitors the
patient during the time that mechanical restraint is used on the patient;
and
(i) The patient is released from the mechanical restraint as soon
as his behavior no longer presents an immediate threat to himself or
others.
2. Mechanical restraint may be used on a person with a disability
who is a patient at a facility and the provisions of subsection 1 do not
apply if the mechanical restraint is used to:
(a) Treat the medical needs of a patient;
(b) Protect a patient who is known to be at risk of injury to
himself because he lacks coordination or suffers from frequent loss of
consciousness;
(c) Provide proper body alignment to a patient; or
(d) Position a patient who has physical disabilities in a manner
prescribed in the patient’s plan of treatment.
3. If mechanical restraint is used on a person with a disability
who is a patient at a facility in an emergency, the use of the procedure
must be reported as a denial of rights pursuant to NRS 449.786 , regardless of whether the use of the
procedure is authorized by statute. The report must be made not later
than 1 working day after the procedure is used.
(Added to NRS by 1999, 3249 )
1. Chemical restraint may only be used on a person with a
disability who is a patient at a facility if:
(a) The patient has been diagnosed as mentally ill, as defined in
NRS 433A.115 , and is receiving mental
health services from a facility;
(b) The chemical restraint is administered to the patient while he
is under the care of the facility;
(c) An emergency exists that necessitates the use of chemical
restraint;
(d) A medical order authorizing the use of chemical restraint is
obtained from the patient’s attending physician or psychiatrist;
(e) The physician or psychiatrist who signed the order required
pursuant to paragraph (d) examines the patient not later than 1 working
day immediately after the administration of the chemical restraint; and
(f) The chemical restraint is administered by a person licensed to
administer medication.
2. If chemical restraint is used on a person with a disability who
is a patient, the use of the procedure must be reported as a denial of
rights pursuant to NRS 449.786 ,
regardless of whether the use of the procedure is authorized by statute.
The report must be made not later than 1 working day after the procedure
is used.
(Added to NRS by 1999, 3250 )
Notwithstanding the provisions of NRS 449.777 to 449.780 ,
inclusive, to the contrary, a facility may use or authorize the use of
physical restraint, mechanical restraint or chemical restraint on a
person with a disability who is a patient if the facility is:
1. Accredited by a nationally recognized accreditation association
or agency; or
2. Certified for participation in the Medicaid or Medicare program,
Ê only to the extent that the accreditation or certification allows the
use of such restraint.
(Added to NRS by 1999, 3248 )
1. Each facility shall develop a program of education for the
members of the staff of the facility to provide instruction in positive
behavioral interventions and positive behavioral supports that:
(a) Includes positive methods to modify the environment of patients
to promote adaptive behavior and reduce the occurrence of inappropriate
behavior;
(b) Includes methods to teach skills to patients so that patients
can replace inappropriate behavior with adaptive behavior;
(c) Includes methods to enhance a patient’s independence and
quality of life;
(d) Includes the use of the least intrusive methods to respond to
and reinforce the behavior of patients; and
(e) Offers a process for designing interventions based upon the
patient that are focused on promoting appropriate changes in behavior as
well as enhancing the overall quality of life for the patient.
2. Each facility shall provide appropriate training for the
members of the staff of the facility who are authorized to carry out and
monitor physical restraint and mechanical restraint to ensure that those
members of the staff are competent and qualified to carry out the
procedures in accordance with NRS 449.765 to 449.786 ,
inclusive.
(Added to NRS by 1999, 3250 )
1. Unless a more severe penalty is prescribed by specific statute,
a person who willfully uses aversive intervention on a person with a
disability who is a patient at a facility or, except as otherwise
provided in NRS 449.781 , violates NRS
449.777 :
(a) For a first violation that does not result in substantial
bodily harm to the person with a disability, is guilty of a gross
misdemeanor.
(b) For a first violation that results in substantial bodily harm
to the person with a disability, is guilty of a category B felony.
(c) For a second or subsequent violation, is guilty of a category B
felony.
Ê A person who is convicted of a category B felony pursuant to this
section shall be punished by imprisonment in the state prison for a
minimum term of not less than 1 year and a maximum term of not more than
6 years, or by a fine of not more than $5,000, or by both fine and
imprisonment.
2. A person who is convicted pursuant to this section is
ineligible for 5 years for employment with a facility.
3. A conviction pursuant to this section is, when applicable,
grounds for disciplinary action against the person so convicted and the
facility where the violation occurred. The Health Division may recommend
to the appropriate agency or board the suspension or revocation of the
professional license, registration, certificate or permit of a person
convicted.
(Added to NRS by 1999, 3251 )
1. A facility where a violation of the provisions of NRS 449.765
to 449.786 , inclusive, occurs shall report the violation
to the Health Division not later than 24 hours after the violation
occurred, or as soon thereafter as the violation is discovered.
2. A facility where a violation occurred shall develop, in
cooperation with the Health Division, a corrective plan to ensure that
within 30 calendar days after the violation occurred, appropriate action
is taken by the facility to prevent future violations.
3. The Health Division shall forward the plan to the Board. The
Board shall review the plan to ensure that it complies with applicable
federal law and the statutes and regulations of this state. The Board may
require appropriate revision of the plan to ensure compliance.
4. If the facility where the violation occurred does not meet the
requirements of the plan to the satisfaction of the Board, the Board may
direct the agency that administers funding for the facility to withhold
state funding for the facility until the facility meets the requirements
of the plan.
(Added to NRS by 1999, 3251 )
An officer,
administrator or employee of a facility licensed pursuant to this chapter
shall not retaliate against any person for having:
1. Reported a violation of NRS 449.765 to 449.786 ,
inclusive; or
2. Provided information regarding a violation of NRS 449.765
to 449.786 , inclusive,
Ê by a facility or a member of the staff of the facility.
(Added to NRS by 1999, 3252 )
1. A denial of rights of a person with a disability who is a
patient of a facility pursuant to NRS 449.765 to 449.786 ,
inclusive, must be entered in the patient’s record. Notice of the denial
must be provided to the administrator of the facility.
2. If the administrator of a facility receives notice of a denial
of rights pursuant to subsection 1, he shall cause a full report to be
prepared which must set forth in detail the factual circumstances
surrounding the denial. A copy of the report must be provided to the
Health Division.
3. The Health Division:
(a) Shall receive reports made pursuant to subsection 2;
(b) May investigate apparent violations of the rights of persons
with disabilities who are patients at facilities; and
(c) May act to resolve disputes relating to apparent violations.
(Added to NRS by 1999, 3252 )
DURABLE POWER OF ATTORNEY FOR HEALTH CARE
As used in NRS 449.800 to 449.860 ,
inclusive, unless the context otherwise requires:
1. “Health care facility” includes:
(a) Any medical facility; and
(b) Any facility for the dependent.
2. “Power of attorney” means a power of attorney for a disabled
principal.
3. “Principal” means a natural person who has executed a power of
attorney for a disabled principal.
4. “Provider of health care” has the meaning ascribed to it in NRS
629.031 .
(Added to NRS by 1987, 913)
Any adult person may execute a power
of attorney for a disabled principal enabling the attorney-in-fact named
in the power of attorney to make decisions concerning health care for the
principal who executed the power of attorney if that principal becomes
incapable of giving informed consent concerning such decisions.
(Added to NRS by 1987, 914)
1. Except as otherwise provided in subsection 2, a principal may
not name as attorney-in-fact in a power of attorney:
(a) His provider of health care;
(b) An employee of his provider of health care;
(c) An operator of a health care facility; or
(d) An employee of a health care facility.
2. A principal may name as attorney-in-fact any person identified
in subsection 1 if that person is the spouse, legal guardian or next of
kin of the principal.
(Added to NRS by 1987, 914; A 1991, 1563)
The form of a power of
attorney for a disabled principal must be substantially as follows:
DURABLE POWER OF ATTORNEY
FOR HEALTH CARE DECISIONS
WARNING TO PERSON EXECUTING THIS DOCUMENT
THIS IS AN IMPORTANT LEGAL DOCUMENT. IT CREATES A DURABLE POWER OF
ATTORNEY FOR HEALTH CARE. BEFORE EXECUTING THIS DOCUMENT, YOU SHOULD KNOW
THESE IMPORTANT FACTS:
1. THIS DOCUMENT GIVES THE PERSON YOU DESIGNATE AS YOUR
ATTORNEY-IN-FACT THE POWER TO MAKE HEALTH CARE DECISIONS FOR YOU. THIS
POWER IS SUBJECT TO ANY LIMITATIONS OR STATEMENT OF YOUR DESIRES THAT YOU
INCLUDE IN THIS DOCUMENT. THE POWER TO MAKE HEALTH CARE DECISIONS FOR YOU
MAY INCLUDE CONSENT, REFUSAL OF CONSENT, OR WITHDRAWAL OF CONSENT TO ANY
CARE, TREATMENT, SERVICE, OR PROCEDURE TO MAINTAIN, DIAGNOSE, OR TREAT A
PHYSICAL OR MENTAL CONDITION. YOU MAY STATE IN THIS DOCUMENT ANY TYPES OF
TREATMENT OR PLACEMENTS THAT YOU DO NOT DESIRE.
2. THE PERSON YOU DESIGNATE IN THIS DOCUMENT HAS A DUTY TO ACT
CONSISTENT WITH YOUR DESIRES AS STATED IN THIS DOCUMENT OR OTHERWISE MADE
KNOWN OR, IF YOUR DESIRES ARE UNKNOWN, TO ACT IN YOUR BEST INTERESTS.
3. EXCEPT AS YOU OTHERWISE SPECIFY IN THIS DOCUMENT, THE POWER OF
THE PERSON YOU DESIGNATE TO MAKE HEALTH CARE DECISIONS FOR YOU MAY
INCLUDE THE POWER TO CONSENT TO YOUR DOCTOR NOT GIVING TREATMENT OR
STOPPING TREATMENT WHICH WOULD KEEP YOU ALIVE.
4. UNLESS YOU SPECIFY A SHORTER PERIOD IN THIS DOCUMENT, THIS
POWER WILL EXIST INDEFINITELY FROM THE DATE YOU EXECUTE THIS DOCUMENT
AND, IF YOU ARE UNABLE TO MAKE HEALTH CARE DECISIONS FOR YOURSELF, THIS
POWER WILL CONTINUE TO EXIST UNTIL THE TIME WHEN YOU BECOME ABLE TO MAKE
HEALTH CARE DECISIONS FOR YOURSELF.
5. NOTWITHSTANDING THIS DOCUMENT, YOU HAVE THE RIGHT TO MAKE
MEDICAL AND OTHER HEALTH CARE DECISIONS FOR YOURSELF SO LONG AS YOU CAN
GIVE INFORMED CONSENT WITH RESPECT TO THE PARTICULAR DECISION. IN
ADDITION, NO TREATMENT MAY BE GIVEN TO YOU OVER YOUR OBJECTION, AND
HEALTH CARE NECESSARY TO KEEP YOU ALIVE MAY NOT BE STOPPED IF YOU OBJECT.
6. YOU HAVE THE RIGHT TO REVOKE THE APPOINTMENT OF THE PERSON
DESIGNATED IN THIS DOCUMENT TO MAKE HEALTH CARE DECISIONS FOR YOU BY
NOTIFYING THAT PERSON OF THE REVOCATION ORALLY OR IN WRITING.
7. YOU HAVE THE RIGHT TO REVOKE THE AUTHORITY GRANTED TO THE
PERSON DESIGNATED IN THIS DOCUMENT TO MAKE HEALTH CARE DECISIONS FOR YOU
BY NOTIFYING THE TREATING PHYSICIAN, HOSPITAL, OR OTHER PROVIDER OF
HEALTH CARE ORALLY OR IN WRITING.
8. THE PERSON DESIGNATED IN THIS DOCUMENT TO MAKE HEALTH CARE
DECISIONS FOR YOU HAS THE RIGHT TO EXAMINE YOUR MEDICAL RECORDS AND TO
CONSENT TO THEIR DISCLOSURE UNLESS YOU LIMIT THIS RIGHT IN THIS DOCUMENT.
9. THIS DOCUMENT REVOKES ANY PRIOR DURABLE POWER OF ATTORNEY FOR
HEALTH CARE.
10. IF THERE IS ANYTHING IN THIS DOCUMENT THAT YOU DO NOT
UNDERSTAND, YOU SHOULD ASK A LAWYER TO EXPLAIN IT TO YOU.
1. DESIGNATION OF HEALTH CARE AGENT.
I,.........................................................................
.....................................................................
(insert your name) do hereby designate and appoint:
Name:
...........................................................................
...................................................
Address:
...........................................................................
..............................................
Telephone Number:
...........................................................................
...........................
as my attorney-in-fact to make health care decisions for me as authorized
in this document.
(Insert the name and address of the person you wish to designate as
your attorney-in-fact to make health care decisions for you. Unless the
person is also your spouse, legal guardian or the person most closely
related to you by blood, none of the following may be designated as your
attorney-in-fact: (1) your treating provider of health care, (2) an
employee of your treating provider of health care, (3) an operator of a
health care facility, or (4) an employee of an operator of a health care
facility.)
2. CREATION OF DURABLE POWER OF ATTORNEY FOR HEALTH CARE.
By this document I intend to create a durable power of attorney by
appointing the person designated above to make health care decisions for
me. This power of attorney shall not be affected by my subsequent
incapacity.
3. GENERAL STATEMENT OF AUTHORITY GRANTED.
In the event that I am incapable of giving informed consent with
respect to health care decisions, I hereby grant to the attorney-in-fact
named above full power and authority to make health care decisions for me
before, or after my death, including: consent, refusal of consent, or
withdrawal of consent to any care, treatment, service, or procedure to
maintain, diagnose, or treat a physical or mental condition, subject only
to the limitations and special provisions, if any, set forth in paragraph
4 or 6.
4. SPECIAL PROVISIONS AND LIMITATIONS.
(Your attorney-in-fact is not permitted to consent to any of the
following: commitment to or placement in a mental health treatment
facility, convulsive treatment, psychosurgery, sterilization, or
abortion. If there are any other types of treatment or placement that you
do not want your attorney-in-fact’s authority to give consent for or
other restrictions you wish to place on his or her attorney-in-fact’s
authority, you should list them in the space below. If you do not write
any limitations, your attorney-in-fact will have the broad powers to make
health care decisions on your behalf which are set forth in paragraph 3,
except to the extent that there are limits provided by law.)
In exercising the authority under this durable power of attorney
for health care, the authority of my attorney-in-fact is subject to the
following special provisions and limitations:
...........................................................................
...........................................................................
.
...........................................................................
...........................................................................
.
...........................................................................
...........................................................................
.
...........................................................................
...........................................................................
.
5. DURATION.
I understand that this power of attorney will exist indefinitely
from the date I execute this document unless I establish a shorter time.
If I am unable to make health care decisions for myself when this power
of attorney expires, the authority I have granted my attorney-in-fact
will continue to exist until the time when I become able to make health
care decisions for myself.
(IF APPLICABLE)
I wish to have this power of attorney end on the following date:......
6. STATEMENT OF DESIRES.
(With respect to decisions to withhold or withdraw life-sustaining
treatment, your attorney-in-fact must make health care decisions that are
consistent with your known desires. You can, but are not required to,
indicate your desires below. If your desires are unknown, your
attorney-in-fact has the duty to act in your best interests; and, under
some circumstances, a judicial proceeding may be necessary so that a
court can determine the health care decision that is in your best
interests. If you wish to indicate your desires, you may INITIAL the
statement or statements that reflect your desires and/or write your own
statements in the space below.)
(If the statement
reflects your desires,
initial the box next to
the statement.)
1. I desire that my life be prolonged to the greatest extent
possible, without regard to my condition, the chances I have for recovery
or long-term survival, or the cost of the procedures......... [ ]
2. If I am in a coma which my doctors have reasonably concluded is
irreversible, I desire that life-sustaining or prolonging treatments not
be used. (Also should utilize provisions of NRS 449.535 to 449.690 ,
inclusive, if this subparagraph is
initialed.)
[............................................ ]
3. If I have an incurable or terminal condition or illness and no
reasonable hope of long-term recovery or survival, I desire that
life-sustaining or prolonging treatments not be used. (Also should
utilize provisions of NRS 449.535 to
449.690 , inclusive, if this
subparagraph is initialed.).........................................
[ ]
4. Withholding or withdrawal of artificial nutrition and hydration
may result in death by starvation or dehydration. I want to receive or
continue receiving artificial nutrition and hydration by way of the
gastrointestinal tract after all other treatment is withheld.
[............................................ ]
5. I do not desire treatment to be provided and/or continued if
the burdens of the treatment outweigh the expected benefits. My
attorney-in-fact is to consider the relief of suffering, the preservation
or restoration of functioning, and the quality as well as the extent of
the possible extension of my life. [ ]
(If you wish to change your answer, you may do so by drawing an “X”
through the answer you do not want, and circling the answer you prefer.)
Other or Additional Statements of
Desires:...................................................................
..
...........................................................................
...........................................................................
.
...........................................................................
...........................................................................
.
...........................................................................
...........................................................................
.
...........................................................................
...........................................................................
.
...........................................................................
...........................................................................
.
7. DESIGNATION OF ALTERNATE ATTORNEY-IN-FACT.
(You are not required to designate any alternative attorney-in-fact
but you may do so. Any alternative attorney-in-fact you designate will be
able to make the same health care decisions as the attorney-in-fact
designated in paragraph 1, page 2, in the event that he or she is unable
or unwilling to act as your attorney-in-fact. Also, if the
attorney-in-fact designated in paragraph 1 is your spouse, his or her
designation as your attorney-in-fact is automatically revoked by law if
your marriage is dissolved.)
If the person designated in paragraph 1 as my attorney-in-fact is
unable to make health care decisions for me, then I designate the
following persons to serve as my attorney-in-fact to make health care
decisions for me as authorized in this document, such persons to serve in
the order listed below:
A. First Alternative Attorney-in-fact
Name:......................................................................
............................................
Address:...................................................................
..........................................
...........................................................................
..................................
Telephone
Number:....................................................................
......................
B. Second Alternative Attorney-in-fact
Name:......................................................................
............................................
Address:...................................................................
..........................................
...........................................................................
..................................
Telephone
Number:....................................................................
......................
8. PRIOR DESIGNATIONS REVOKED.
I revoke any prior durable power of attorney for health care.
(YOU MUST DATE AND SIGN THIS POWER OF ATTORNEY)
I sign my name to this Durable Power of Attorney for Health care
on ……............………. (date) at ....…….…….........……………. (city),
...…....….............. (state)
...........................................................................
(Signature)
(THIS POWER OF ATTORNEY WILL NOT BE VALID FOR MAKING HEALTH CARE
DECISIONS UNLESS IT IS EITHER (1) SIGNED BY AT LEAST TWO QUALIFIED
WITNESSES WHO ARE PERSONALLY KNOWN TO YOU AND WHO ARE PRESENT WHEN YOU
SIGN OR ACKNOWLEDGE YOUR SIGNATURE OR (2) ACKNOWLEDGED BEFORE A NOTARY
PUBLIC.)
CERTIFICATE OF ACKNOWLEDGMENT OF NOTARY PUBLIC
(You may use acknowledgment before a notary public instead of the
statement of witnesses.)
State of Nevada }
}ss.
County of............................................. }
On this ................ day of ................, in the year ...,
before me, ................................ (here insert name of notary
public) personally appeared ................................ (here insert
name of principal) personally known to me (or proved to me on the basis
of satisfactory evidence) to be the person whose name is subscribed to
this instrument, and acknowledged that he or she executed it. I declare
under penalty of perjury that the person whose name is ascribed to this
instrument appears to be of sound mind and under no duress, fraud, or
undue influence.
NOTARY
SEAL
(Signature of Notary Public)
STATEMENT OF WITNESSES
(You should carefully read and follow this witnessing procedure. This
document will not be valid unless you comply with the witnessing
procedure. If you elect to use witnesses instead of having this document
notarized you must use two qualified adult witnesses. None of the
following may be used as a witness: (1) a person you designate as the
attorney-in-fact, (2) a provider of health care, (3) an employee of a
provider of health care, (4) the operator of a health care facility, (5)
an employee of an operator of a health care facility. At least one of the
witnesses must make the additional declaration set out following the
place where the witnesses sign.)
I declare under penalty of perjury that the principal is personally
known to me, that the principal signed or acknowledged this durable power
of attorney in my presence, that the principal appears to be of sound
mind and under no duress, fraud, or undue influence, that I am not the
person appointed as attorney-in-fact by this document, and that I am not
a provider of health care, an employee of a provider of health care, the
operator of a community care facility, nor an employee of an operator of
a health care facility.
Signature:.............................................................
Residence Address:..............................
Print Name:...........................................................
Date:......................................................................
Signature:.............................................................
Residence Address:..............................
Print Name:...........................................................
Date:......................................................................
(AT LEAST ONE OF THE ABOVE WITNESSES MUST ALSO SIGN THE FOLLOWING
DECLARATION.)
I declare under penalty of perjury that I am not related to the
principal by blood, marriage, or adoption, and to the best of my
knowledge I am not entitled to any part of the estate of the principal
upon the death of the principal under a will now existing or by operation
of law.
Signature:.................................................................
................
Signature:.................................................................
................
---------------------------------------------------------------------------
--------------------------------------
Names:..................................................................
Address:.................................................
Print Name:...........................................................
Date:......................................................................
COPIES: You should retain an executed copy of this document and give one
to your attorney-in-fact. The power of attorney should be available so a
copy may be given to your providers of health care.
(Added to NRS by 1987, 915; A 1991, 638, 1564; 1993, 562, 2793)
1. The principal’s signature on the power of attorney must:
(a) Be acknowledged before a notary public; or
(b) Witnessed by two adult witnesses who know the principal
personally.
2. Neither of the witnesses to a principal’s signature may be:
(a) A provider of health care;
(b) An employee of a provider of health care;
(c) An operator of a health care facility;
(d) An employee of a health care facility; or
(e) The attorney-in-fact.
3. At least one of the witnesses to a principal’s signature must
be a person who is:
(a) Not related to the principal by blood, marriage or adoption; and
(b) To the best of the witnesses knowledge, not entitled to any
part of the estate of the principal upon the death of the principal.
(Added to NRS by 1987, 914)
1. The attorney-in-fact may not consent to:
(a) Commitment or placement of the principal in a facility for
treatment of mental illness;
(b) Convulsive treatment;
(c) Psychosurgery;
(d) Sterilization;
(e) Abortion;
(f) Aversive intervention, as that term is defined in NRS 449.766
; or
(g) Any other treatment to which the principal, in the power of
attorney, states that the attorney-in-fact may not consent.
2. The attorney-in-fact must make decisions concerning the use or
nonuse of life sustaining treatment which conform to the known desires of
the principal. The principal may make these desires known in the power of
attorney.
(Added to NRS by 1987, 914; A 1999, 3252 )
1. The principal may designate an alternate attorney-in-fact.
2. If a principal designates his spouse as the attorney-in-fact or
as an alternate, that designation is automatically revoked if the
principal and his spouse are divorced.
3. An execution of a power of attorney automatically revokes any
previous power of attorney.
4. A power of attorney remains valid indefinitely unless:
(a) The principal designates a shorter period for which it is to
remain valid; or
(b) It is revoked.
5. If a power of attorney expires while the principal is unable to
make decisions concerning health care, the power of attorney remains
valid until the principal is again able to make such decisions.
(Added to NRS by 1987, 914)
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