2005 Nevada Revised Statutes - Chapter 449 — Medical and Other Related Facilities

CHAPTER 449 - MEDICAL AND OTHER RELATEDFACILITIES

LICENSING, REGULATION AND INSPECTION

NRS 449.001 Definitions.

NRS 449.0015 Agencyto provide nursing in the home defined.

NRS 449.0021 Agencyto provide personal care services in the home defined.

NRS 449.0025 Boarddefined.

NRS 449.0031 Communitytriage center defined.

NRS 449.0033 Facilityfor hospice care defined.

NRS 449.0038 Facilityfor intermediate care defined.

NRS 449.00385 Facilityfor modified medical detoxification defined.

NRS 449.00387 Facilityfor refractive surgery defined.

NRS 449.0039 Facilityfor skilled nursing defined.

NRS 449.004 Facilityfor the care of adults during the day defined.

NRS 449.0045 Facilityfor the dependent defined.

NRS 449.00455 Facilityfor the treatment of abuse of alcohol or drugs defined. [Effective throughJune 30, 2007.]

NRS 449.00455 Facilityfor the treatment of abuse of alcohol or drugs defined. [Effective July 1,2007.]

NRS 449.0046 Facilityfor the treatment of irreversible renal disease defined.

NRS 449.0055 Facilityfor transitional living for released offenders defined.

NRS 449.008 Halfwayhouse for recovering alcohol and drug abusers defined.

NRS 449.009 HealthDivision defined.

NRS 449.0105 Homefor individual residential care defined.

NRS 449.0115 Hospicecare defined.

NRS 449.012 Hospitaldefined.

NRS 449.013 Independentcenter for emergency medical care defined.

NRS 449.0145 Licensedpractical nurse defined.

NRS 449.0151 Medicalfacility defined.

NRS 449.01515 Mobile unit defined.

NRS 449.0152 Nursingassistant defined.

NRS 449.0153 Nursingpool defined.

NRS 449.0155 Obstetriccenter defined.

NRS 449.0156 Palliativeservices defined.

NRS 449.0157 Providerof health care defined.

NRS 449.0159 Providerof supported living arrangement services defined.

NRS 449.0165 Psychiatrichospital defined.

NRS 449.0167 Registerednurse defined.

NRS 449.017 Residentialfacility for groups defined.

NRS 449.0175 Ruralclinic defined.

NRS 449.0177 Ruralhospital defined.

NRS 449.0185 Supportedliving arrangement services defined.

NRS 449.019 Surgicalcenter for ambulatory patients defined.

NRS 449.0195 Terminallyill defined.

NRS 449.021 Classificationof hospitals.

NRS 449.026 Misleadingname or other designation of facility prohibited.

NRS 449.030 Licenserequired to operate or maintain facility or to operate program of hospice care.

NRS 449.0305 Businessesthat provide referrals to residential facilities for groups: License required;standards and regulations; provision of referrals; prohibited acts; civilpenalties.

NRS 449.031 Requirementsfor program of hospice care.

NRS 449.0315 Provisionof care by facility for hospice care.

NRS 449.032 Admissionof dentist to membership on medical staff of hospital.

NRS 449.034 Physicianand nurse required to operate independent center to provide emergency medicalcare.

NRS 449.035 Supervisionof facility for skilled nursing or facility for intermediate care.

NRS 449.0355 Supervisionof residential facility for groups.

NRS 449.0356 Certificationrequired for alcohol and drug abuse programs operated or provided by facilityfor transitional living for released offenders. [Effective through June 30,2007.]

NRS 449.0356 Certificationrequired for alcohol and drug abuse programs operated or provided by facilityfor transitional living for released offenders. [Effective July 1, 2007.]

NRS 449.0357 Continuingeducation requirements concerning care of persons with dementia for certainemployees of facilities for skilled nursing, facilities for intermediate careand residential facilities for groups.

NRS 449.036 Requirementsfor obstetric center.

NRS 449.037 Adoptionof standards, qualifications and other regulations.

NRS 449.038 Regulationof other facilities.

NRS 449.040 Applicationfor license: Filing; contents.

NRS 449.050 Fees;exemption.

NRS 449.060 Expirationand renewal of license.

NRS 449.063 Olderpatient defined.

NRS 449.065 Suretybond required for initial license and renewal of license to operate facilityfor intermediate care, facility for skilled nursing, residential facility forgroups, agency to provide personal care services in home and agency to providenursing in home; exemption; exception.

NRS 449.067 Substitutefor surety bond required for initial license and renewal of license to operatefacility for intermediate care, facility for skilled nursing, residentialfacility for groups, agency to provide personal care services in home andagency to provide nursing in home.

NRS 449.068 Suretybond required for initial license and renewal of license to operate facilityfor refractive surgery.

NRS 449.069 Substitutefor surety bond required for initial license and renewal of license to operatefacility for refractive surgery.

NRS 449.070 Facilitiesexempt from NRS 449.001 to 449.240, inclusive.

NRS 449.080 License:Issuance; validity; transferability.

NRS 449.085 License:Form; contents.

NRS 449.087 License:Amendment required for addition of certain services.

NRS 449.091 Provisionallicense.

NRS 449.095 Operatorof residential facility for groups: Posting of license and rates for services.

NRS 449.140 Moneyreceived from licensing of facilities to be deposited in State General Fund;expenditure of state or federal money.

NRS 449.150 Powersof Health Division.

NRS 449.160 Administrativesanctions: Imposition by Health Division; general grounds for denial,suspension or revocation of license; revocation of license in connection withcertain nuisance activities; log of complaints; written report.

NRS 449.163 Administrativesanctions: Imposition by Health Division; disposition of money collected.

NRS 449.165 Administrativesanctions: Regulations of Board.

NRS 449.170 Denial,suspension or revocation of license or imposition of sanctions: Notice; appeal;adoption of regulations.

NRS 449.172 Residentialfacility for groups: Duties of Health Division and operator upon suspension orrevocation of license for abuse, neglect or isolation of occupants.

NRS 449.173 Applicabilityof provisions governing investigation and consequences of criminal history ofcertain persons.

NRS 449.176 Investigationof criminal history of applicant for license to operate certain facility.

NRS 449.179 Initialand periodic investigations of criminal history of employee or independent contractorof certain agency or facility.

NRS 449.182 Maintenanceand availability of certain records regarding employees and independentcontractors of certain agencies and facilities.

NRS 449.185 Terminationof employment or contract of employee or independent contractor of certainagency or facility who has been convicted of certain crime; liability of agencyor facility.

NRS 449.188 Denial,suspension or revocation of license to operate certain facility or agency:Conviction of applicant or licensee of certain crime or continued employment ofperson convicted of certain crime.

NRS 449.191 Medicalfacility not required to allow abortions.

NRS 449.195 Waiverof deductible or copayment; conditions.

NRS 449.200 Disclosureof results of inspections of certain facilities.

NRS 449.205 Medicalfacility prohibited from retaliating or discriminating against certain personsfor reporting or participating in investigation or proceeding relating tosentinel event or certain conduct of physician or reporting or refusing toprovide nursing services beyond his competence; restriction of right prohibited.

NRS 449.207 Retaliationor discrimination in violation of NRS449.205: Legal remedy.

NRS 449.210 Penaltiesfor unlicensed operation: Medical facility or facility for dependent;residential facility for groups.

NRS 449.220 Actionto enjoin violations.

NRS 449.230 Entryand inspection of building and premises.

NRS 449.235 Inspectionof medical facility and facility for dependent by Health Division and AgingServices Division.

NRS 449.240 Institutionand conduct of prosecutions.

MISCELLANEOUS PROVISIONS

NRS 449.243 Itemizedlist of charges required; use of Uniform Billing and Claims Forms authorized;contracted rates; summary of charges.

NRS 449.244 Certaincosts for examination or treatment of victims of sexual offenses to be chargedto county.

NRS 449.245 Releaseof child from hospital; provision of authorization for release and otherinformation to Division of Child and Family Services; disclosure ofinformation; penalty.

NRS 449.246 Hospitalor obstetric center to provide information relating to voluntary acknowledgmentor establishment of paternity before discharging unmarried woman who has bornechild; regulations.

NRS 449.2465 Personsentitled to results of tests performed at laboratory regarding patient of ruralhospital.

NRS 449.247 Nursingassistants and training of nursing assistants: Powers and duties of HealthDivision and State Board of Nursing; provision of information to State Board ofNursing.

NRS 449.248 Additionalservices to be provided by agency to provide nursing in home.

NRS 449.2485 Returnto dispensing pharmacy of unused prescription drug dispensed to patient offacility for skilled nursing or facility for intermediate care for purpose ofreissuing drug to fill other prescriptions for patients in facility.

HOMES FOR INDIVIDUAL RESIDENTIAL CARE

NRS 449.249 Licenserequired for operation of home; application for license; minimal standards forlicensing.

NRS 449.2493 Authorityof Health Division and Aging Services Division of Department of Health andHuman Services.

NRS 449.2496 Penaltiesfor unlicensed operation or maintenance of home.

NEVADA HEALTH FACILITIES ASSISTANCE ACT

NRS 449.250 Shorttitle.

NRS 449.260 Definitions.

NRS 449.270 StateDepartment to constitute sole agency of State for certain purposes.

NRS 449.280 Dutiesof State Department.

NRS 449.300 Inventoryof existing health facilities; development of program for construction offacilities.

NRS 449.310 Requirementsof program for construction of health facilities.

NRS 449.320 Applicationfor federal money; deposit of money.

NRS 449.340 StateDepartment to prescribe minimum standards; standards to supersede localordinances and regulations; penalty.

NRS 449.360 Applicationfor construction of health facility: Filing; compliance with federal and staterequirements.

NRS 449.370 Applicationfor construction of health facility: Notice and hearing; approval andforwarding.

NRS 449.380 Inspectionof construction of health facility; certification by State Department.

NRS 449.390 Authorityto receive and distribute federal money; Health Facilities Assistance Fund;deposits, use and controls.

NRS 449.400 StatePublic Health Facilities Construction Assistance Fund: Creation; administration.

NRS 449.410 Stateassistance for construction of certain projects; eligibility of project forassistance.

NRS 449.420 Amountof state assistance: Allocations; payments.

NRS 449.430 Moneyfrom State Public Health Facilities Construction Assistance Fund to be paid ininstallments.

ACCOUNTING; FINANCIAL REPORTS; FEES; ENSURING QUALITY OF CARE

NRS 449.450 Definitions.

NRS 449.460 Powersof Director.

NRS 449.465 Authorityof Director to impose fees; maximum amount of fees collected; fee for supportof Legislative Committee on Health Care.

NRS 449.470 Directormay use staff or contract for services.

NRS 449.476 Committeeto ensure quality of care: Formation by hospital; general requirements.

NRS 449.485 Hospitalrequired to use form for all patients discharged; regulations; hospitals withmore than 100 beds to provide information on magnetic tape or by other means;exemption.

NRS 449.490 Financialstatements and reports required to be filed with Department; additionalreporting requirements for hospitals with 100 or more beds.

NRS 449.500 Directorto carry out analyses and studies concerning cost of health care.

NRS 449.510 Directorto prepare and file summaries, compilations or other reports; publicinspection; collection, maintenance, disclosure or publication of contracts oridentification of party to contract prohibited.

NRS 449.520 Reportto Governor, Legislative Committee on Health Care and Interim FinanceCommittee; contents; Legislative Committee on Health Care to developcomprehensive plan concerning provision of health care.

NRS 449.530 Administrativefine for violation.

WITHHOLDING OR WITHDRAWAL OF LIFE-SUSTAINING TREATMENT

NRS 449.535 Shorttitle; uniformity of application and construction.

NRS 449.540 Definitions.

NRS 449.550 Attendingphysician defined.

NRS 449.560 Declarationdefined.

NRS 449.570 Life-sustainingtreatment defined.

NRS 449.575 Persondefined.

NRS 449.581 Providerof health care defined.

NRS 449.585 Qualifiedpatient defined.

NRS 449.590 Terminalcondition defined.

NRS 449.600 Declarationrelating to use of life-sustaining treatment.

NRS 449.610 Formof declaration directing physician to withhold or withdraw life-sustainingtreatment.

NRS 449.613 Formof declaration designating another person to decide to withhold or withdrawlife-sustaining treatment.

NRS 449.617 Timedeclaration becomes operative; duty of providers of health care.

NRS 449.620 Revocationof declaration; entry of revocation in medical records of declarant.

NRS 449.622 Recordingdetermination of terminal condition and declaration.

NRS 449.624 Treatmentof qualified patients; withholding or withdrawal of artificial nutrition andhydration; treatment of pregnant patient.

NRS 449.626 Writtenconsent to withhold or withdraw life-sustaining treatment.

NRS 449.628 Transferof care of declarant.

NRS 449.630 Immunityfrom civil and criminal liability and discipline for unprofessional conduct.

NRS 449.640 Considerationof declaration and other factors; failure to follow directions of patient.

NRS 449.645 Assumptionof validity of declaration; presumption of intent to use, withhold or withdrawlife-sustaining treatment not created.

NRS 449.650 Deathdoes not constitute suicide or homicide; effect of declaration on policy ofinsurance; prohibiting or requiring execution of declaration prohibited ascondition for insurance or receipt of health care.

NRS 449.660 Penalties.

NRS 449.670 Actionscontrary to reasonable medical standards not required; mercy-killing, assistedsuicide or euthanasia not authorized.

NRS 449.680 Otherright or responsibility regarding use of life-sustaining treatment orwithholding or withdrawal of medical care not limited.

NRS 449.690 Validityof declaration executed in another state; effect of previously executedinstrument.

PATIENTS RIGHTS

NRS 449.700 Facilityor home to provide necessary services or arrange for transfer of patient;explanation of need for transfer and alternatives available.

NRS 449.705 Facilityor home to forward medical records upon certain transfers of patient.

NRS 449.710 Specificrights: Information concerning facility; treatment; billing; visitation.

NRS 449.715 Specificrights: Designation of persons authorized to visit patient in facility.

NRS 449.720 Specificrights: Care; refusal of treatment and experimentation; privacy; notice ofappointments and need for care.

NRS 449.730 Patientto be informed of rights upon admission to facility or home for individualcare; required disclosures and notices.

NRS 449.740 Procedureto insert implant in breast of patient: Informed consent required; withdrawalof consent; penalty.

NRS 449.750 Procedureto insert implant in breast of patient: Contents of explanation form andconsent form; fee for forms.

PREVENTING PERSONS FROM ENTERING OR EXITING HEALTH FACILITY

NRS 449.760 Unlawfulto prevent person from entering or exiting office of physician or healthfacility or center; exceptions; penalty.

USE OF AVERSIVE INTERVENTION OR FORMS OF RESTRAINT ON PATIENTSWITH DISABILITIES

NRS 449.765 Definitions.

NRS 449.766 Aversiveintervention defined.

NRS 449.767 Chemicalrestraint defined.

NRS 449.768 Corporalpunishment defined.

NRS 449.769 Electricshock defined.

NRS 449.770 Emergencydefined.

NRS 449.771 Facilitydefined.

NRS 449.772 Mechanicalrestraint defined.

NRS 449.773 Personwith a disability defined.

NRS 449.774 Physicalrestraint defined.

NRS 449.775 Verbaland mental abuse defined.

NRS 449.776 Aversiveintervention: Prohibition on use.

NRS 449.777 Formsof restraint: Restrictions on use.

NRS 449.778 Physicalrestraint: Permissible use; report of use in emergency.

NRS 449.779 Mechanicalrestraint: Permissible use; report of use in emergency.

NRS 449.780 Chemicalrestraint: Permissible use; report of use.

NRS 449.781 Useof forms of restraint by certain facilities.

NRS 449.782 Educationand training of members of staff of facility.

NRS 449.783 Violations:Criminal penalties; ineligibility for employment; disciplinary action.

NRS 449.784 Violations:Report required; development and review of and compliance with corrective plan.

NRS 449.785 Prohibitionon retaliation against person for reporting or providing information regardingviolation.

NRS 449.786 Entryof denial of rights in patients record; notice and report of denial; action byHealth Division.

DURABLE POWER OF ATTORNEY FOR HEALTH CARE

NRS 449.800 Definitions.

NRS 449.810 Executionof power of attorney to make decisions concerning health care; conditions.

NRS 449.820 Personsnot eligible for designation as attorney-in-fact.

NRS 449.830 Powerof attorney: Form.

NRS 449.840 Powerof attorney: Acknowledgment; witnesses.

NRS 449.850 Attorney-in-fact:Prohibited acts; duties.

NRS 449.860 Designationof attorney-in-fact: Alternate; revocation; validity; expiration.

_________

LICENSING, REGULATION AND INSPECTION

NRS 449.001 Definitions. As used in this chapter, unless the context otherwiserequires, the words and terms defined in NRS449.0015 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)

NRS 449.0015 Agencyto provide nursing in the home defined. Agencyto provide nursing in the home means any person or governmental organizationwhich provides in the home, through its employees or by contractual arrangementwith other persons, skilled nursing and assistance and training in health andhousekeeping skills. The term does not include a provider of supported living arrangementservices during any period in which the provider of supported living arrangementservices is engaged in providing supported living arrangement services.

(Added to NRS by 1979, 160; A 1985, 1737; 2005, 1379)

NRS 449.0021 Agencyto provide personal care services in the home defined.

1. Agency to provide personal care services in thehome means any person, other than a natural person, which provides in thehome, through its employees or by contractual arrangement with other persons,nonmedical services related to personal care to elderly persons or persons withmental or physical disabilities to assist those persons with activities ofdaily 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 ofpersonal hygiene.

2. The term does not include:

(a) An independent contractor who provides nonmedicalservices specified by subsection 1 without the assistance of employees; or

(b) A microboard, as defined by regulations adopted bythe Board.

(Added to NRS by 2005, 2164)

NRS 449.0025 Boarddefined. Board means the State Board ofHealth.

(Added to NRS by 1985, 1735)

NRS 449.0031 Communitytriage center defined. Community triagecenter means a facility that provides on a 24-hour basis medical assessmentsof and short-term monitoring services for mentally ill persons and abusers ofalcohol or drugs in a manner which does not require that the assessments andservices be provided in a licensed hospital.

(Added to NRS by 2005, 532)

NRS 449.0033 Facilityfor hospice care defined. Facility forhospice care means a facility which is operated to provide hospice care.

(Added to NRS by 1999, 248)

NRS 449.0038 Facilityfor intermediate care defined. Facility forintermediate care means an establishment operated and maintained to provide24-hour personal and medical supervision, for a person who does not haveillness, disease, injury or other condition that would require the degree ofcare and treatment which a hospital or facility for skilled nursing is designedto provide.

(Added to NRS by 1973, 1279; A 1985, 1737; 1991,1974)

NRS 449.00385 Facilityfor modified medical detoxification defined. Facilityfor modified medical detoxification means a facility that provides 24-hourmedical monitoring of treatment and detoxification in a manner which does not requirethat the service be provided in a licensed hospital.

(Added to NRS by 1999, 969)

NRS 449.00387 Facilityfor refractive surgery defined. Facility forrefractive surgery means a freestanding facility that provides limited medicalservices for the evaluation of patients with refractive errors of the eye andthe surgical treatment of those patients.

(Added to NRS by 2001, 1339; A 2005, 2693)

NRS 449.0039 Facilityfor skilled nursing defined.

1. Facility for skilled nursing means anestablishment which provides continuous skilled nursing and related care asprescribed by a physician to a patient in the facility who is not in an acuteepisode of illness and whose primary need is the availability of such care on acontinuous basis.

2. Facility for skilled nursing does not include afacility which meets the requirements of a general or any other specialhospital.

(Added to NRS by 1973, 1279; A 1985,1738)(Substituted in revision for NRS 449.018)

NRS 449.004 Facilityfor the care of adults during the day defined. Facilityfor the care of adults during the day means an establishment operated andmaintained to provide care during the day on a temporary or permanent basis foraged or infirm persons. The term does not include a halfway house forrecovering alcohol and drug abusers.

(Added to NRS by 1983, 1657; A 1985, 1736; 2001, 2518)

NRS 449.0045 Facilityfor the dependent defined. Facility for thedependent includes:

1. A facility for the treatment of abuse of alcohol ordrugs;

2. A halfway house for recovering alcohol and drugabusers;

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 thehome; and

6. A facility for transitional living for releasedoffenders.

(Added to NRS by 1985, 1735; A 2001, 2518; 2005, 2165, 2350)

NRS 449.00455 Facilityfor the treatment of abuse of alcohol or drugs defined. [Effective throughJune 30, 2007.] Facility for the treatment ofabuse of alcohol or drugs means any public or private establishment whichprovides residential treatment, including mental and physical restoration, ofabusers of alcohol or drugs and which is certified by the Health Divisionpursuant to subsection 4 of NRS 458.025.It does not include a medical facility or services offered by volunteers orvoluntary organizations.

(Added to NRS by 1975, 366; A 1985, 1736; 1993, 1624;1999, 1871; 2001, 417)

NRS 449.00455 Facility for the treatment of abuseof alcohol or drugs defined. [Effective July 1, 2007.] Facility for the treatment of abuse of alcohol or drugsmeans any public or private establishment which provides residential treatment,including mental and physical restoration, of abusers of alcohol or drugs andwhich is certified by the Division of Mental Health and Developmental Servicesof the Department of Health and Human Services pursuant to subsection 4 of NRS 458.025. It does not include a medicalfacility 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 SpecialSession, 56, effective July 1, 2007)

NRS 449.0046 Facilityfor the treatment of irreversible renal disease defined. Facility for the treatment of irreversible renal diseasemeans a facility that is not part of a hospital and which provides peritonealdialysis or hemodialysis or trains a person with a permanent irreversible renalimpairment to perform dialysis for himself.

(Added to NRS by 1985, 1735)

NRS 449.0055 Facilityfor transitional living for released offenders defined.

1. Facility for transitional living for releasedoffenders means a residence that provides housing and a living environment forpersons who have been released from prison and who require assistance withreintegration into the community, other than such a residence that is operatedor maintained by a state or local government or an agency thereof. The termdoes not include a halfway house for recovering alcohol and drug abusers or afacility for the treatment of abuse of alcohol or drugs.

2. As used in this section, person who has beenreleased 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 ofParole and Probation of the Department of Public Safety through residentialconfinement pursuant to NRS 213.371 to 213.410, inclusive.

(d) A person who has been released from prison byexpiration of his term of sentence.

(Added to NRS by 2005, 2349)

NRS 449.008 Halfwayhouse for recovering alcohol and drug abusers defined. Halfway house for recovering alcohol and drug abusersmeans a residence that provides housing and a living environment for recoveringalcohol and drug abusers and is operated to facilitate their reintegration intothe community, but does not provide any treatment for alcohol or drug abuse.The term does not include a facility for transitional living for releasedoffenders.

(Added to NRS by 2001, 2518; A 2005, 2350)

NRS 449.009 HealthDivision defined. Health Division means theHealth Division of the Department of Health and Human Services.

(Added to NRS by 1973, 1279; A 1973, 1406)

NRS 449.0105 Homefor individual residential care defined. Homefor individual residential care means a home in which a natural personfurnishes food, shelter, assistance and limited supervision, for compensation,to not more than two persons who are aged, infirm, mentally retarded orhandicapped, unless the persons receiving those services are related within thethird degree of consanguinity or affinity to the person providing thoseservices. The term does not include:

1. A halfway house for recovering alcohol and drugabusers; or

2. A home in which supported living arrangementservices are provided by a provider of supported living arrangement servicesduring any period in which the provider of supported living arrangementservices is engaged in providing supported living arrangement services.

(Added to NRS by 1993, 2556; A 2001, 2518; 2005, 1380)

NRS 449.0115 Hospicecare defined.

1. Hospice care means a centrally administeredprogram of palliative services and supportive services provided by aninterdisciplinary team directed by a physician. The program includes theprovision of physical, psychological, custodial and spiritual care for personswho are terminally ill and their families. The care may be provided in thehome, at a residential facility or at a medical facility at any time of the dayor night. The term includes the supportive care and services provided to thefamily after the patient dies.

2. As used in this section:

(a) Family includes the immediate family, the personwho primarily cared for the patient and other persons with significant personalties to the patient, whether or not related by blood.

(b) Interdisciplinary team means a group of personswho work collectively to meet the special needs of terminally ill patients andtheir 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)

NRS 449.012 Hospitaldefined. Hospital means an establishment forthe diagnosis, care and treatment of human illness, including care available 24hours each day from persons licensed to practice professional nursing who areunder the direction of a physician, services of a medical laboratory andmedical, radiological, dietary and pharmaceutical services.

(Added to NRS by 1973, 1279; A 1985, 1737)

NRS 449.013 Independentcenter for emergency medical care defined. Independentcenter for emergency medical care means a facility, structurally separate anddistinct from a hospital, which provides limited services for the treatment ofa medical emergency.

(Added to NRS by 1985, 1735)

NRS 449.0145 Licensedpractical nurse defined. Licensed practicalnurse has the meaning ascribed to it in NRS632.016.

(Added to NRS by 2005, 1517)

NRS 449.0151 Medicalfacility defined. Medical facilityincludes:

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 renaldisease;

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)

NRS 449.01515 Mobileunit defined.

1. Except as otherwise provided in subsection 2,mobile unit means a motor vehicle that is specially designed, constructed andequipped to provide any of the medical services provided by a medical facilitydescribed 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 medicalfacility described in subsections 1 to 13, inclusive, of NRS 449.0151 which is accredited by theJoint Commission on Accreditation of Healthcare Organizations or the AmericanOsteopathic Association;

(b) A motor vehicle that is operated by a health centerthat 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 permitissued pursuant to chapter 450B of NRS.

(Added to NRS by 2001, 1339; A 2003, 421)

NRS 449.0152 Nursingassistant defined. Nursing assistant hasthe meaning ascribed to it in NRS 632.0166.

(Added to NRS by 2005, 1517)

NRS 449.0153 Nursingpool defined. Nursing pool means a personor agency which provides for compensation, through its employees or bycontractual arrangement with other persons, nursing services to any naturalperson, medical facility or facility for the dependent. The term does notinclude:

1. An independent contractor who provides suchservices without the assistance of employees;

2. A nursing pool based in a medical facility orfacility for the dependent; or

3. A provider of supported living arrangement servicesduring any period in which the provider of supported living arrangementservices is engaged in providing supported living arrangement services.

(Added to NRS by 1989, 303; A 2005, 1380)

NRS 449.0155 Obstetriccenter defined. Obstetric center means a facilitythat is not part of a hospital and provides services for normal, uncomplicatedbirths.

(Added to NRS by 1985, 1735)

NRS 449.0156 Palliativeservices defined. Palliative services meansservices and treatments directed toward the control of pain and symptoms whichprovide the greatest degree of relief for the longest period while minimizingany adverse effects of the services and treatments, including, withoutlimitation, any side effects of any medications given or administered.

(Added to NRS by 2005, 485)

NRS 449.0157 Providerof health care defined. Provider of healthcare has the meaning ascribed to it in NRS629.031.

(Added to NRS by 1995, 1600)

NRS 449.0159 Providerof supported living arrangement services defined. Providerof supported living arrangement services means a natural person who or apartnership, firm, corporation, association, state or local government oragency thereof that has been issued a certificate pursuant to NRS 435.3305 to 435.339, inclusive, and the regulationsadopted pursuant to NRS 435.3305 to 435.339, inclusive.

(Added to NRS by 2005, 1379)

NRS 449.0165 Psychiatrichospital defined. Psychiatric hospitalmeans a hospital for the diagnosis, care and treatment of mental illness whichprovides 24-hour residential care.

(Added to NRS by 1985, 1735)

NRS 449.0167 Registerednurse defined. Registered nurse has themeaning ascribed to it in NRS 632.019.

(Added to NRS by 2005, 1517)

NRS 449.017 Residentialfacility for groups defined.

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, mentallyretarded or handicapped person. The term includes, without limitation, anassisted living facility.

2. The term does not include:

(a) An establishment which provides care only duringthe day;

(b) A natural person who provides care for no more thantwo persons in his own home;

(c) A natural person who provides care for one or morepersons related to him within the third degree of consanguinity or affinity;

(d) A halfway house for recovering alcohol and drugabusers; or

(e) A facility funded by a division or program of theDepartment 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)

NRS 449.0175 Ruralclinic defined. Rural clinic means afacility located in an area that is not designated as an urban area by theBureau of the Census, where medical services are provided by a physicianassistant or an advanced practitioner of nursing under the supervision of alicensed physician.

(Added to NRS by 1985, 1735; A 2001, 782)

NRS 449.0177 Ruralhospital defined. Rural hospital means ahospital with 85 or fewer beds which is:

1. The sole institutional provider of health carelocated within a county whose population is less than 100,000;

2. The sole institutional provider of health carelocated 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)

NRS 449.0185 Supportedliving arrangement services defined. Supportedliving arrangement services has the meaning ascribed to it in NRS 435.3315.

(Added to NRS by 2005, 1379)

NRS 449.019 Surgicalcenter for ambulatory patients defined. Surgicalcenter for ambulatory patients means a facility with limited medical servicesavailable for diagnosis or treatment of patients by surgery where the patientsrecovery, in the opinion of the surgeon, will not require care as a patient inthe facility for more than 24 hours.

(Added to NRS by 1975, 366; A 1985, 1736; 1993, 207)

NRS 449.0195 Terminallyill defined. Terminally ill means a medicaldiagnosis made by a physician that a person has an anticipated life expectancyof not more than 12 months.

(Added to NRS by 2005, 485)

NRS 449.021 Classificationof hospitals.

1. A hospital which provides only one or two of thefollowing categories of service:

(a) Medical;

(b) Surgical;

(c) Obstetrical; or

(d) Psychiatric,

shall bedesignated a medical hospital, surgical hospital, obstetrical hospital orpsychiatric 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 ageneral hospital.

(Added to NRS by 1971, 933; A 1973, 1280)

NRS 449.026 Misleadingname or other designation of facility prohibited. Thename, sign, listing or other designation of a medical facility or facility forthe dependent must not contain any terms misleading to the public with regardto the services offered.

(Added to NRS by 1973, 1279; A 1975, 367; 1985, 1738)

NRS 449.030 Licenserequired to operate or maintain facility or to operate program of hospice care.

1. No person, state or local government or agencythereof may operate or maintain in this State any medical facility or facilityfor 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, aperson, state or local government or agency thereof shall not operate a programof hospice care without first obtaining a license for the program from theBoard.

[Part 1:336:1951](NRS A 1971, 934; 1973, 1281; 1985,1738; 1989, 1035; 1997, 444, 1484; 1999, 249, 3608)

NRS 449.0305 Businessesthat provide referrals to residential facilities for groups: License required;standards and regulations; provision of referrals; prohibited acts; civilpenalties.

1. Except as otherwise provided in subsection 5, aperson must obtain a license from the Board to operate a business that providesreferrals to residential facilities for groups.

2. The Board shall adopt:

(a) Standards for the licensing of businesses thatprovide referrals to residential facilities for groups;

(b) Standards relating to the fees charged by suchbusinesses;

(c) Regulations governing the licensing of suchbusinesses; and

(d) Regulations establishing requirements for trainingthe employees of such businesses.

3. A licensed nurse, social worker, physician orhospital, or a provider of geriatric care who is licensed as a nurse or socialworker, may provide referrals to residential facilities for groups through abusiness that is licensed pursuant to this section. The Board may, byregulation, authorize a public guardian or any other person it determinesappropriate to provide referrals to residential facilities for groups through abusiness that is licensed pursuant to this section.

4. A business that is licensed pursuant to thissection or an employee of such a business shall not:

(a) Refer a person to a residential facility for groupsthat is not licensed.

(b) Refer a person to a residential facility for groupsthat is owned by the same person who owns the business.

A person whoviolates the provisions of this subsection is liable for a civil penalty to berecovered by the Attorney General in the name of the State Board of Health forthe first offense of not more than $10,000 and for a second or subsequentoffense of not less than $10,000 nor more than $20,000. Unless otherwiserequired by federal law, the State Board of Health shall deposit all civilpenalties collected pursuant to this section into a separate account in the StateGeneral Fund to be used for the enforcement of this section and the protectionof the health, safety, well-being and property of residences of residentialfacilities for groups.

5. This section does not apply to a medical facilitythat is licensed pursuant to NRS 449.001to 449.240, inclusive, on October 1,1999.

(Added to NRS by 1999, 3606)

NRS 449.031 Requirementsfor program of hospice care. No person, stateor local government or agency may represent that it provides hospice careunless the program of care, either directly or indirectly:

1. Has a medical director whose responsibilities areappropriate 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 interdisciplinaryteam which provides the hospice care;

2. Is provided to the patient, as needed, in thepatients home, at a residential facility and at a medical facility, at anytime of the day or night;

3. Includes medical, nursing, psychological andpastoral care and social services at the level required by the patientscondition;

4. Provides supportive services for the patientsimmediate family and other persons with significant personal ties to thepatient, whether or not related by blood, including:

(a) Care for the patient which provides a respite fromthe stresses and responsibilities that result from the daily care of thepatient; and

(b) Emotional support and other care after the patientdies; and

5. Includes the services of trained volunteers.

(Added to NRS by 1989, 1034)

NRS 449.0315 Provisionof care by facility for hospice care.

1. A licensed facility for hospice care may provideany of the following levels of care for terminally ill patients:

(a) Medical care for a patient who is in an acuteepisode of illness;

(b) Skilled nursing care;

(c) Intermediate care;

(d) Custodial care; and

(e) Palliative services.

2. A licensed facility for hospice care may providedirect supportive services to a patients family and persons who provide carefor the patient, including services which provide care for the patient duringthe day and other services which provide a respite from the stresses andresponsibilities that result from the daily care of the patient.

(Added to NRS by 1989, 1034; A 1999, 249; 2005, 485)

NRS 449.032 Admissionof dentist to membership on medical staff of hospital.No dentist may be:

1. Automatically admitted to membership on the medicalstaff of a hospital solely because he is licensed as a dentist in this state oris authorized pursuant to NRS 631.267 toperform certain functions; or

2. Denied admission to membership on the medical staffof a hospital merely because he is licensed as a dentist and not as aphysician.

(Added to NRS by 1985, 2097)

NRS 449.034 Physicianand nurse required to operate independent center to provide emergency medicalcare. An independent center to provideemergency medical care shall not be operated unless a physician and registerednurse are on the premises.

(Added to NRS by 1985, 1735)

NRS 449.035 Supervisionof facility for skilled nursing or facility for intermediate care.

1. Except as otherwise provided in subsection 2, afacility for skilled nursing or facility for intermediate care licensedpursuant to the provisions of NRS 449.001to 449.240, inclusive, may not beoperated except under the supervision of a nursing facility administrator whois at the facility and licensed under the provisions of chapter 654 of NRS.

2. The provisions of subsection 1 do not apply to afacility for intermediate care which limits its care and treatment to thosepersons who are mentally retarded or who have conditions related to mentalretardation.

(Added to NRS by 1969, 672; A 1971, 934; 1973, 1281;1977, 1031; 1985, 1738; 1993, 1214)

NRS 449.0355 Supervisionof residential facility for groups. Aresidential facility for groups must not be operated except under thesupervision of an administrator of a residential facility for groups licensedpursuant to the provisions of chapter 654 ofNRS.

(Added to NRS by 1993, 2144)

NRS 449.0356 Certificationrequired for alcohol and drug abuse programs operated or provided by facilityfor transitional living for released offenders. [Effective through June 30,2007.] Each alcohol and drug abuse programoperated or provided by a facility for transitional living for released offendersmust be certified by the Health Division in accordance with the requirementsset forth in chapter 458 of NRS and anyregulations adopted pursuant thereto. As used in this section, alcohol anddrug abuse program has the meaning ascribed to it in NRS 458.010.

(Added to NRS by 2005, 2350)

NRS 449.0356 Certification required for alcoholand drug abuse programs operated or provided by facility for transitionalliving for released offenders. [Effective July 1, 2007.] Each alcohol and drug abuse program operated or providedby a facility for transitional living for released offenders must be certifiedby the Division of Mental Health and Developmental Services of the Departmentof Health and Human Services in accordance with the requirements set forth in chapter 458 of NRS and any regulations adoptedpursuant thereto. As used in this section, alcohol and drug abuse program hasthe meaning ascribed to it in NRS 458.010.

(Added to NRS by 2005, 2350; A 2005, 22nd SpecialSession, 67, effective July 1, 2007)

NRS 449.0357 Continuingeducation requirements concerning care of persons with dementia for certainemployees of facilities for skilled nursing, facilities for intermediate careand residential facilities for groups.

1. The Board shall establish minimum continuingeducation requirements concerning the care of persons with any form ofdementia, including, without limitation, dementia caused by Alzheimersdisease, for each person who is:

(a) Employed by a facility for skilled nursing,facility for intermediate care or residential facility for groups whichprovides care to persons with any form of dementia; and

(b) Licensed or certified by an occupational licensingboard.

2. In establishing continuing education requirementspursuant to subsection 1, the Board shall consider any other educationalrequirements imposed on such employees to ensure that the continuing educationrequirements established by the Board do not duplicate or conflict with theexisting educational requirements imposed on those employees.

3. The administrator of a facility for skillednursing, facility for intermediate care or residential facility for groupswhich provides care to persons with any form of dementia, including, withoutlimitation, dementia caused by Alzheimers disease, shall ensure that eachemployee of the facility who is required to comply with the requirements forcontinuing education established by the Board pursuant to this section complieswith such requirements.

(Added to NRS by 2003, 856)

NRS 449.036 Requirementsfor obstetric center. An obstetric centermust:

1. Provide sufficient space for members of the familyof the pregnant woman and other persons chosen by the woman to assist her withthe birth; and

2. Have obstetrical services available to meet theneeds of an acute patient.

(Added to NRS by 1985, 1735)

NRS 449.037 Adoptionof standards, qualifications and other regulations.

1. The Board shall adopt:

(a) Licensing standards for each class of medicalfacility or facility for the dependent covered by NRS 449.001 to 449.240, inclusive, and for programs ofhospice care.

(b) Regulations governing the licensing of suchfacilities and programs.

(c) Regulations governing the procedure and standardsfor granting an extension of the time for which a natural person may providecertain care in his home without being considered a residential facility forgroups pursuant to NRS 449.017. The regulationsmust require that such grants are effective only if made in writing.

(d) Regulations establishing a procedure for theindemnification by the Health Division, from the amount of any surety bond orother obligation filed or deposited by a facility for refractive surgerypursuant to NRS 449.068 or 449.069, of a patient of the facility whohas sustained any damages as a result of the bankruptcy of or any breach ofcontract by the facility.

(e) Any other regulations as it deems necessary orconvenient to carry out the provisions of NRS449.001 to 449.240, inclusive.

2. The Board shall adopt separate regulationsgoverning the licensing and operation of:

(a) Facilities for the care of adults during the day;and

(b) Residential facilities for groups,

whichprovide care to persons with Alzheimers disease.

3. The Board shall adopt separate regulations for:

(a) The licensure of rural hospitals which take intoconsideration the unique problems of operating such a facility in a rural area.

(b) The licensure of facilities for refractive surgerywhich take into consideration the unique factors of operating such a facility.

(c) The licensure of mobile units which take intoconsideration the unique factors of operating a facility that is not in a fixedlocation.

4. The Board shall require that the practices andpolicies of each medical facility or facility for the dependent provideadequately for the protection of the health, safety and physical, moral andmental well-being of each person accommodated in the facility.

5. The Board shall establish minimum qualificationsfor administrators and employees of residential facilities for groups. Inestablishing the qualifications, the Board shall consider the related standardsset by nationally recognized organizations which accredit such facilities.

6. The Board shall adopt separate regulationsregarding the assistance which may be given pursuant to NRS 453.375 and 454.213 to an ultimate user of controlledsubstances or dangerous drugs by employees of residential facilities forgroups. The regulations must require at least the following conditions beforesuch assistance may be given:

(a) The ultimate users physical and mental conditionis stable and is following a predictable course.

(b) The amount of the medication prescribed is at amaintenance level and does not require a daily assessment.

(c) A written plan of care by a physician or registerednurse has been established that:

(1) Addresses possession and assistance in theadministration of the medication; and

(2) Includes a plan, which has been preparedunder the supervision of a registered nurse or licensed pharmacist, for emergencyintervention if an adverse condition results.

(d) The prescribed medication is not administered byinjection or intravenously.

(e) The employee has successfully completed trainingand examination approved by the Health Division regarding the authorized mannerof assistance.

7. The Board shall adopt separate regulationsgoverning the licensing and operation of residential facilities for groupswhich provide assisted living services. The Board shall not allow the licensingof a facility as a residential facility for groups which provides assistedliving services and a residential facility for groups shall not claim that itprovides assisted living services unless:

(a) Before authorizing a person to move into thefacility, the facility makes a full written disclosure to the person regardingwhat services of personalized care will be available to the person and theamount that will be charged for those services throughout the residents stayat the facility.

(b) The residents of the facility reside in their ownliving units which:

(1) Except as otherwise provided in subsection8, contain toilet facilities;

(2) Contain a sleeping area or bedroom; and

(3) Are shared with another occupant only uponconsent of both occupants.

(c) The facility provides personalized care to theresidents of the facility and the general approach to operating the facilityincorporates these core principles:

(1) The facility is designed to create aresidential environment that actively supports and promotes each residentsquality of life and right to privacy;

(2) The facility is committed to offeringhigh-quality supportive services that are developed by the facility incollaboration with the resident to meet the residents individual needs;

(3) The facility provides a variety of creativeand innovative services that emphasize the particular needs of each individualresident and his personal choice of lifestyle;

(4) The operation of the facility and itsinteraction with its residents supports, to the maximum extent possible, eachresidents need for autonomy and the right to make decisions regarding his ownlife;

(5) The operation of the facility is designed tofoster a social climate that allows the resident to develop and maintainpersonal relationships with fellow residents and with persons in the generalcommunity;

(6) The facility is designed to minimize and isoperated in a manner which minimizes the need for its residents to move out ofthe facility as their respective physical and mental conditions change overtime; and

(7) The facility is operated in such a manner asto 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 therequirement of subparagraph (1) of paragraph (b) of subsection 7 to a facilitylicensed as a residential facility for groups on or before July 1, 2005, andwhich is authorized to have 10 or fewer beds and was originally constructed asa single-family dwelling, if the Health Division finds that:

(a) Strict application of that requirement would resultin economic hardship to the facility requesting the exception; and

(b) The exception, if granted, would not:

(1) Cause substantial detriment to the health orwelfare of any resident of the facility;

(2) Result in more than two residents sharing atoilet facility; or

(3) Otherwise impair substantially the purposeof that requirement.

9. The Board shall, if it determines necessary, adoptregulations and requirements to ensure that each residential facility forgroups and its staff are prepared to respond to an emergency, including,without limitation:

(a) The adoption of plans to respond to a naturaldisaster and other types of emergency situations, including, withoutlimitation, an emergency involving fire;

(b) The adoption of plans to provide for the evacuationof a residential facility for groups in an emergency, including, withoutlimitation, plans to ensure that nonambulatory patients may be evacuated;

(c) Educating the residents of residential facilitiesfor groups concerning the plans adopted pursuant to paragraphs (a) and (b); and

(d) Posting the plans or a summary of the plans adoptedpursuant to paragraphs (a) and (b) in a conspicuous place in each residentialfacility for groups.

10. The regulations governing the licensing andoperation of facilities for transitional living for released offenders mustprovide for the licensure of at least three different types of facilities,including, without limitation:

(a) Facilities that only provide a housing and livingenvironment;

(b) Facilities that provide or arrange for theprovision of supportive services for residents of the facility to assist theresidents with reintegration into the community, in addition to providing ahousing and living environment; and

(c) Facilities that provide or arrange for theprovision of alcohol and drug abuse programs, in addition to providing ahousing and living environment and providing or arranging for the provision ofother supportive services.

11. As used in this section, living unit means anindividual 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)

NRS 449.038 Regulationof other facilities. The Board may adopt regulationsrequiring the licensing of a facility other than those required to be licensedpursuant to NRS 449.001 to 449.240, inclusive, if the:

1. Facility provides any type of medical care ortreatment; and

2. Regulation is necessary to protect the health ofthe general public.

(Added to NRS by 1985, 1735)

NRS 449.040 Applicationfor license: Filing; contents. Any person,state or local government or agency thereof desiring a license under theprovisions of NRS 449.001 to 449.240, inclusive, must file with theHealth Division an application on a form prescribed, prepared and furnished bythe 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 typeof care to be offered, as defined in the regulations.

5. The number of beds authorized by the Director ofthe Department of Health and Human Services or, if such authorization is notrequired, 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 theHealth Division for the proper administration and enforcement of NRS 449.001 to 449.240, inclusive.

8. Evidence satisfactory to the Health Division thatthe applicant is of reputable and responsible character. If the applicant is afirm, association, organization, partnership, business trust, corporation orcompany, similar evidence must be submitted as to the members thereof, and theperson in charge of the facility for which application is made. If theapplicant is a political subdivision of the State or other governmental agency,similar evidence must be submitted as to the person in charge of the institutionfor which application is made.

9. Evidence satisfactory to the Health Division of theability of the applicant to comply with the provisions of NRS 449.001 to 449.240, inclusive, and the standards andregulations adopted by the Board.

10. Evidence satisfactory to the Health Division thatthe facility conforms to the zoning regulations of the local government withinwhich the facility will be operated or that the applicant has applied for anappropriate reclassification, variance, permit for special use or otherexception for the facility.

[2:336:1951](NRS A 1963, 959; 1971, 934; 1973, 1281;1975, 367; 1985, 1739; 1987, 776; 1991, 1078)

NRS 449.050 Fees;exemption.

1. Except as otherwise provided in subsection 2, eachapplication for a license must be accompanied by such fee as may be determinedby regulation of the Board. The Board may, by regulation, allow or requirepayment of a fee for a license in installments and may fix the amount of eachpayment and the date that the payment is due.

2. A facility for the care of adults during the day isexempt from the fees imposed by the Board pursuant to this section.

3. The fee imposed by the Board for a facility fortransitional living for released offenders must be based on the type offacility that is being licensed and must be calculated to produce the revenueestimated to cover the costs related to the license, but in no case may a feefor a license exceed the actual cost to the Health Division of issuing orrenewing the license.

4. If an application for a license for a facility fortransitional living for released offenders is denied, any amount of the feepaid pursuant to this section that exceeds the expenses and costs incurred bythe 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)

NRS 449.060 Expirationand renewal of license.

1. Each license issuedpursuant to NRS 449.001 to 449.240, inclusive, expires on December 31following its issuance and is renewable for 1 year upon reapplication andpayment of all fees required pursuant to NRS449.050 unless the Health Division finds, after an investigation, that thefacility has not:

(a) Satisfactorily complied with the provisions of NRS 449.001 to 449.240, inclusive, or the standards andregulations adopted by the Board;

(b) Obtained the approval of the Director of theDepartment of Health and Human Services before undertaking a project, if suchapproval is required by NRS 439A.100;or

(c) Conformed to all applicable local zoningregulations.

2. Each reapplication for an agency to providepersonal care services in the home, an agency to provide nursing in the home, aresidential facility for intermediate care, a facility for skilled nursing or aresidential facility for groups must include, without limitation, a statementthat 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)

NRS 449.063 Olderpatient defined. As used in this section and NRS 449.065 and 449.067, older patient means a patientwho is 60 years of age or older.

(Added to NRS by 1997, 1482)

NRS 449.065 Suretybond required for initial license and renewal of license to operate facilityfor intermediate care, facility for skilled nursing, residential facility forgroups, agency to provide personal care services in home and agency to providenursing in home; exemption; exception.

1. Except as otherwise provided in subsections 6 and 7and NRS 449.067, each facility forintermediate care, facility for skilled nursing, residential facility forgroups, agency to provide personal care services in the home and agency toprovide nursing in the home shall, when applying for a license or renewing alicense, file with the Administrator of the Health Division a surety bond:

(a) If the facility or agency employs less than 7employees, in the amount of $5,000;

(b) If the facility or agency employs at least 7 butnot more than 25 employees, in the amount of $25,000; or

(c) If the facility or agency employs more than 25employees, in the amount of $50,000.

2. A bond filed pursuant to this section must beexecuted by the facility or agency as principal and by a surety company assurety. The bond must be payable to the Aging Services Division of theDepartment of Health and Human Services and must be conditioned to provideindemnification to an older patient who the Specialist for the Rights ofElderly Persons determines has suffered property damage as a result of any actor failure to act by the facility or agency to protect the property of theolder patient.

3. Except when a surety is released, the surety bondmust cover the period of the initial license to operate or the period of therenewal, as appropriate.

4. A surety on any bond filed pursuant to this sectionmay be released after the surety gives 30 days written notice to theAdministrator of the Health Division, but the release does not discharge orotherwise affect any claim filed by an older patient for property damaged as aresult of any act or failure to act by the facility or agency to protect theproperty of the older patient alleged to have occurred while the bond was ineffect.

5. A license is suspended by operation of law when thefacility or agency is no longer covered by a surety bond as required by thissection or by a substitute for the surety bond pursuant to NRS 449.067. The Administrator of theHealth Division shall give the facility or agency at least 20 days writtennotice before the release of the surety or the substitute for the surety, tothe effect that the license will be suspended by operation of law until anothersurety bond or substitute for the surety bond is filed in the same manner andamount as the bond or substitute being terminated.

6. The Administrator of the Health Division may exempta residential facility for groups from the requirement of filing a surety bondpursuant to this section if the Administrator determines that the requirementwould result in undue hardship to the residential facility for groups.

7. The requirement of filing a surety bond set forthin this section does not apply to a facility for intermediate care, facilityfor skilled nursing, residential facility for groups, agency to providepersonal care services in the home or agency to provide nursing in the homethat is operated and maintained by the State of Nevada or an agency thereof.

(Added to NRS by 1997, 1482; A 2003, 524; 2005, 2168)

NRS 449.067 Substitutefor surety bond required for initial license and renewal of license to operatefacility for intermediate care, facility for skilled nursing, residentialfacility for groups, agency to provide personal care services in home andagency to provide nursing in home.

1. As a substitute for the surety bond requiredpursuant to NRS 449.065, a facility forintermediate care, a facility for skilled nursing, a residential facility forgroups, an agency to provide personal care services in the home and an agencyto provide nursing in the home may deposit with any bank or trust companyauthorized to do business in this State, upon approval from the Administratorof the Health Division:

(a) An obligation of a bank, savings and loanassociation, thrift company or credit union licensed to do business in thisState;

(b) Bills, bonds, notes, debentures or otherobligations of the United States or any agency or instrumentality thereof, orguaranteed 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, orguaranteed by this State, in an aggregate amount, based upon principal amountor market value, whichever is lower.

2. The obligations of a bank, savings and loanassociation, thrift company or credit union must be held to secure the sameobligation as would the surety bond required by NRS 449.065. With the approval of theAdministrator of the Health Division, the depositor may substitute othersuitable obligations for those deposited, which must be assigned to the AgingServices Division of the Department of Health and Human Services and arenegotiable only upon approval by the Administrator of the Aging ServicesDivision.

3. Any interest or dividends earned on the depositaccrue to the account of the depositor.

4. The deposit must be an amount at least equal to thesurety bond required by NRS 449.065 andmust state that the amount may not be withdrawn except by direct and sole orderof the Administrator of the Aging Services Division.

(Added to NRS by 1997, 1483; A 2003, 525; 2005, 2169)

NRS 449.068 Suretybond required for initial license and renewal of license to operate facilityfor refractive surgery.

1. Except as otherwise provided in NRS 449.069, each facility for refractivesurgery shall, when applying for a license or renewing a license, file with theAdministrator of the Health Division a surety bond:

(a) If the facility employs less than 7 employees, inthe amount of $10,000;

(b) If the facility employs at least 7 but not morethan 25 employees, in the amount of $50,000; or

(c) If the facility employs more than 25 employees, inthe amount of $100,000.

2. A bond filed pursuant to this section must beexecuted by the facility as principal and by a surety company as surety. Thebond must be payable to the Health Division and must be conditioned to provideindemnification to a patient of the facility who the Administrator of theHealth Division or his designee determines has sustained any damages as aresult of the bankruptcy of or any breach of contract by the facility.

3. Except when a surety is released, the surety bondmust cover the period of the initial license to operate or the period of therenewal, as appropriate.

4. A surety on any bond filed pursuant to this sectionmay be released after the surety gives 30 days written notice to theAdministrator of the Health Division, but the release does not discharge orotherwise affect any claim filed by a patient for any damages sustained as aresult of the bankruptcy of or any breach of contract by the facility while thebond was in effect.

5. The license of a facility for refractive surgery issuspended by operation of law when the facility is no longer covered by asurety bond as required by this section or by a substitute for the surety bondpursuant to NRS 449.069. The Administratorof the Health Division shall give the facility at least 20 days written noticebefore the release of the surety or the substitute for the surety, to theeffect that the license will be suspended by operation of law until anothersurety bond is filed or substitute for the surety bond is deposited in the samemanner and amount as the bond or substitute being terminated.

(Added to NRS by 2001, 1340; A 2005, 2696)

NRS 449.069 Substitutefor surety bond required for initial license and renewal of license to operatefacility for refractive surgery.

1. As a substitute for the surety bond requiredpursuant to NRS 449.068, a facility forrefractive surgery may deposit with any bank or trust company authorized to dobusiness in this State, upon approval of the Administrator of the Health Division:

(a) An obligation of a bank, savings and loanassociation, thrift company or credit union licensed to do business in thisState;

(b) Bills, bonds, notes, debentures or other obligationsof the United States or any agency or instrumentality thereof, or guaranteed bythe United States; or

(c) Any obligation of this State or any city, county,town, township, school district or other instrumentality of this State, orguaranteed by this State, in an aggregate amount, based upon principal amountor market value, whichever is lower.

2. The obligations of a bank, savings and loanassociation, thrift company or credit union must be held to secure the sameobligation as would the surety bond required by NRS 449.068. With the approval of theAdministrator of the Health Division, the facility may substitute othersuitable obligations for those deposited, which must be assigned to the HealthDivision and are negotiable only upon approval of the Administrator of theHealth Division.

3. Any interest or dividends earned on the depositaccrue to the account of the facility.

4. The deposit must be an amount at least equal to thesurety bond required by NRS 449.068 andmust state that the amount may not be withdrawn except by the direct and soleorder of the Administrator of the Health Division.

(Added to NRS by 2001, 1340; A 2005, 2696)

NRS 449.070 Facilitiesexempt from NRS449.001 to 449.240, inclusive. The provisions of NRS449.001 to 449.240, inclusive, donot apply to:

1. Any facility conducted by and for the adherents ofany church or religious denomination for the purpose of providing facilitiesfor the care and treatment of the sick who depend solely upon spiritual meansthrough prayer for healing in the practice of the religion of the church ordenomination, except that such a facility shall comply with all regulations relativeto 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 dependentoperated 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)

NRS 449.080 License:Issuance; validity; transferability.

1. If, after investigation, the Health Division findsthat the:

(a) Applicant is in full compliance with the provisionsof NRS 449.001 to 449.240, inclusive;

(b) Applicant is in substantial compliance with thestandards and regulations adopted by the Board;

(c) Applicant, if he has undertaken a project for whichapproval is required pursuant to NRS439A.100, has obtained the approval of the Director of the Department ofHealth and Human Services; and

(d) Facility conforms to the applicable zoning regulations,

the HealthDivision shall issue the license to the applicant.

2. A license applies only to the person to whom it isissued, is valid only for the premises described in the license and is nottransferable.

[Part 3:336:1951](NRS A 1963, 959; 1971, 935; 1973,1283; 1985, 1740; 1987, 777; 1991, 1078)

NRS 449.085 License:Form; contents. Each license issued by theHealth Division shall be in the form prescribed by the Division and shallcontain:

1. The name of the person or persons authorized tooperate such licensed facility;

2. The location of such licensed facility; and

3. The number of beds authorized in such licensedfacility, the nature of services offered and the service delivery capacity.

(Added to NRS by 1973, 1279; A 1975, 367)

NRS 449.087 License:Amendment required for addition of certain services.

1. A licensee must obtain the approval of the HealthDivision to amend his license to operate a facility before the addition of anyof 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 toamend a license to allow a facility to provide any of the services described insubsection 1 if the applicant satisfies the requirements contained in NRS 449.080. The Health Division may revokeits approval if the licensee fails to maintain substantial compliance with standardsapproved by the Board for the provision of such services, or with any conditionsincluded in the written approval of the Director issued pursuant to theprovisions of NRS 439A.100.

3. The Board shall consider standards adopted byappropriate national organizations as a guide for adopting standards for theapproval of the provision of services pursuant to this section.

(Added to NRS by 1987, 876; A 1989, 1948)

NRS 449.091 Provisionallicense.

1. The Health Division may cancel the license of amedical facility or facility for the dependent and issue a provisional license,effective for a period determined by the Health Division, to such a facility ifit:

(a) Is in operation at the time of the adoption ofstandards and regulations pursuant to the provisions of NRS 449.001 to 449.240, inclusive, and the Health Divisiondetermines that the facility requires a reasonable time under the particularcircumstances within which to comply with the standards and regulations; or

(b) Has failed to comply with the standards orregulations and the Health Division determines that the facility is in theprocess of making the necessary changes or has agreed to make the changeswithin a reasonable time.

2. The provisions of subsection 1 do not require theissuance of a license or prevent the Health Division from refusing to renew orfrom revoking or suspending any license where the Health Division deems suchaction necessary for the health and safety of the occupants of any facility.

(Added to NRS by 1973, 1279; A 1985, 1740)

NRS 449.095 Operatorof residential facility for groups: Posting of license and rates for services. A person who operates a residential facility for groupsshall:

1. Post his license to operate the residentialfacility for groups; and

2. Post the rates for services provided by theresidential facility for groups,

in aconspicuous place in the residential facility for groups.

(Added to NRS by 1999, 3606)

NRS 449.140 Moneyreceived from licensing of facilities to be deposited in State General Fund;expenditure of state or federal money.

1. Money received from licensing medical facilitiesand facilities for the dependent must be forwarded to the State Treasurer fordeposit in the State General Fund.

2. The Health Division shall enforce the provisions ofNRS 449.001 to 449.245, inclusive, and may incur anynecessary expenses not in excess of money appropriated for that purpose by theState 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)

NRS 449.150 Powersof Health Division. The Health Division may:

1. Upon receipt of an application for a license,conduct an investigation into the premises, facilities, qualifications ofpersonnel, methods of operation, policies and purposes of any person proposingto engage in the operation of a medical facility or a facility for thedependent. The facility is subject to inspection and approval as to standardsfor safety from fire, on behalf of the Health Division, by the State FireMarshal.

2. Upon receipt of a complaint against a medicalfacility or facility for the dependent, except for a complaint concerning thecost of services, conduct an investigation into the premises, facilities,qualifications of personnel, methods of operation, policies, procedures andrecords of that facility or any other medical facility or facility for thedependent which may have information pertinent to the complaint.

3. Employ such professional, technical and clericalassistance 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)

NRS 449.160 Administrativesanctions: Imposition by Health Division; general grounds for denial,suspension or revocation of license; revocation of license in connection withcertain nuisance activities; log of complaints; written report.

1. The Health Division may deny an application for alicense or may suspend or revoke any license issued under the provisions of NRS 449.001 to 449.240, inclusive, upon any of thefollowing grounds:

(a) Violation by the applicant or the licensee of anyof the provisions of NRS 439B.410 or 449.001 to 449.245, inclusive, or of any other law ofthis State or of the standards, rules and regulations adopted thereunder.

(b) Aiding, abetting or permitting the commission ofany illegal act.

(c) Conduct inimical to the public health, morals,welfare and safety of the people of the State of Nevada in the maintenance andoperation of the premises for which a license is issued.

(d) Conduct or practice detrimental to the health orsafety of the occupants or employees of the facility.

(e) Failure of the applicant to obtain written approvalfrom the Director of the Department of Health and Human Services as required byNRS 439A.100 or as provided in anyregulation adopted pursuant to this chapter, if such approval is required.

2. In addition to the provisions of subsection 1, theHealth Division may revoke a license to operate a facility for the dependentif, with respect to that facility, the licensee that operates the facility, oran 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 nuisancepursuant to NRS 244.360, 244.3603 or 268.4124; or

(c) Is ordered by the appropriate governmental agencyto correct a violation of a building, safety or health code or regulation butfails to correct the violation.

3. The Health Division shall maintain a log of anycomplaints that it receives relating to activities for which the HealthDivision may revoke the license to operate a facility for the dependentpursuant 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 CounselBureau a written report setting forth, for the previous biennium:

(a) Any complaints included in the log maintained bythe Health Division pursuant to subsection 3; and

(b) Any disciplinary actions taken by the HealthDivision 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)

NRS 449.163 Administrativesanctions: Imposition by Health Division; disposition of money collected.

1. If a medical facility or facility for the dependentviolates 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 accordancewith the regulations adopted pursuant to NRS449.165 may:

(a) Prohibit the facility from admitting any patientuntil it determines that the facility has corrected the violation;

(b) Limit the occupancy of the facility to the numberof beds occupied when the violation occurred, until it determines that thefacility 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 notto exceed 10 percent per annum; and

(d) Appoint temporary management to oversee the operationof the facility and to ensure the health and safety of the patients of thefacility, until:

(1) It determines that the facility hascorrected the violation and has management which is capable of ensuringcontinued compliance with the applicable statutes, conditions, standards andregulations; or

(2) Improvements are made to correct theviolation.

2. If the facility fails to pay any administrativepenalty imposed pursuant to paragraph (c) of subsection 1, the Health Divisionmay:

(a) Suspend the license of the facility until theadministrative penalty is paid; and

(b) Collect court costs, reasonable attorneys fees andother costs incurred to collect the administrative penalty.

3. The Health Division may require any facility thatviolates 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 necessaryto correct the violation.

4. Any money collected as administrative penaltiespursuant to this section must be accounted for separately and used to protectthe health or property of the residents of the facility in accordance withapplicable federal standards.

(Added to NRS by 1989, 863; A 1989, 1663; 2003, 858)

NRS 449.165 Administrativesanctions: Regulations of Board. The Boardshall adopt regulations establishing the criteria for the imposition of eachsanction prescribed by NRS 449.163.These regulations must:

1. Prescribe the circumstances and manner in whicheach sanction applies;

2. Minimize the time between identification of aviolation and the imposition of a sanction;

3. Provide for the imposition of incrementally moresevere sanctions for repeated or uncorrected violations; and

4. Provide for less severe sanctions for lesserviolations of applicable state statutes, conditions, standards or regulations.

(Added to NRS by 1989, 864)

NRS 449.170 Denial,suspension or revocation of license or imposition of sanctions: Notice; appeal;adoption of regulations.

1. When the Health Division intends to deny, suspendor revoke a license, or impose any sanction prescribed by NRS 449.163, it shall give reasonablenotice to all parties by certified mail. The notice must contain the legalauthority, jurisdiction and reasons for the action to be taken. Notice is notrequired if the Health Division finds that the public health requires immediateaction. In that case, it may order a summary suspension of a license or imposeany sanction prescribed by NRS 449.163,pending proceedings for revocation or other action.

2. If a person wants to contest the action of theHealth Division, he must file an appeal pursuant to regulations adopted by theBoard.

3. Upon receiving notice of an appeal, the HealthDivision shall hold a hearing pursuant to regulations adopted by the Board.

4. The Board shall adopt such regulations as arenecessary 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)

NRS 449.172 Residentialfacility for groups: Duties of Health Division and operator upon suspension orrevocation of license for abuse, neglect or isolation of occupants. If the Health Division suspends or revokes the license ofa person who operates a residential facility for groups for abuse, neglect orisolation of the occupants of the facility, the Division shall suspend orrevoke the license of all residential facilities for groups operated by thatperson. The person who operates the facility shall move all of the persons whoare receiving services in the residential facilities for groups to otherlicensed residential facilities for groups at his own expense.

(Added to NRS by 1999, 3607)

NRS 449.173 Applicabilityof provisions governing investigation and consequences of criminal history ofcertain persons. The provisions of NRS 449.176 to 449.188, inclusive, do not apply to anyfacility for the treatment of abuse of alcohol or drugs.

(Added to NRS by 1997, 442)

NRS 449.176 Investigationof criminal history of applicant for license to operate certain facility.

1. Each applicant for a license to operate a facilityfor intermediate care, facility for skilled nursing or residential facility forgroups shall submit to the Central Repository for Nevada Records of CriminalHistory two complete sets of fingerprints for submission to the Federal Bureauof Investigation for its report.

2. The Central Repository for Nevada Records ofCriminal History shall determine whether the applicant has been convicted of acrime listed in paragraph (a) of subsection 1 of NRS 449.188 and immediately inform theadministrator of the facility, if any, and the Health Division of whether theapplicant has been convicted of such a crime.

(Added to NRS by 1997, 442)

NRS 449.179 Initialand periodic investigations of criminal history of employee or independentcontractor of certain agency or facility.

1. Except asotherwise provided in subsection 2, within 10 days after hiring an employee orentering into a contract with an independent contractor, the administrator of,or the person licensed to operate, an agency to provide personal care servicesin the home, an agency to provide nursing in the home, a facility forintermediate care, a facility for skilled nursing or a residential facility forgroups shall:

(a) Obtain awritten statement from the employee or independent contractor stating whetherhe has been convicted of any crime listed in NRS449.188;

(b) Obtain anoral and written confirmation of the information contained in the writtenstatement obtained pursuant to paragraph (a);

(c) Obtain fromthe employee or independent contractor two sets of fingerprints and a writtenauthorization to forward the fingerprints to the Central Repository for NevadaRecords of Criminal History for submission to the Federal Bureau of Investigationfor its report; and

(d) Submit tothe Central Repository for Nevada Records of Criminal History the fingerprintsobtained pursuant to paragraph (c).

2. The administratorof, or the person licensed to operate, an agency to provide personal careservices in the home, an agency to provide nursing in the home, a facility forintermediate care, a facility for skilled nursing or a residential facility forgroups is not required to obtain the information described in subsection 1 froman employee or independent contractor who provides proof that an investigationof his criminal history has been conducted by the Central Repository for NevadaRecords of Criminal History within the immediately preceding 6 months and theinvestigation did not indicate that the employee or independent contractor hadbeen convicted of any crime set forth in NRS449.188.

3. The administratorof, or the person licensed to operate, an agency to provide personal careservices in the home, an agency to provide nursing in the home, a facility forintermediate care, a facility for skilled nursing or a residential facility forgroups shall ensure that the criminal history of each employee or independentcontractor who works at the agency or facility is investigated at least onceevery 5 years. The administrator or person shall:

(a) If theagency or facility does not have the fingerprints of the employee orindependent contractor on file, obtain two sets of fingerprints from theemployee or independent contractor;

(b) Obtainwritten authorization from the employee or independent contractor to forwardthe fingerprints on file or obtained pursuant to paragraph (a) to the CentralRepository for Nevada Records of Criminal History for submission to the FederalBureau of Investigation for its report; and

(c) Submit thefingerprints to the Central Repository for Nevada Records of Criminal History.

4. Uponreceiving fingerprints submitted pursuant to this section, the CentralRepository for Nevada Records of Criminal History shall determine whether the employeeor independent contractor has been convicted of a crime listed in NRS 449.188 and immediately inform theHealth Division and the administrator of, or the person licensed to operate,the agency or facility at which the person works whether the employee orindependent contractor has been convicted of such a crime.

5. The Central Repository for Nevada Records ofCriminal History may impose a fee upon an agency or a facility that submitsfingerprints pursuant to this section for the reasonable cost of theinvestigation. The agency or facility may recover from the employee orindependent contractor not more than one-half of the fee imposed by the CentralRepository. If the agency or facility requires the employee or independentcontractor to pay for any part of the fee imposed by the Central Repository, itshall allow the employee or independent contractor to pay the amount throughperiodic payments.

(Added to NRS by 1997, 442; A 1999, 1946; 2005, 2170)

NRS 449.182 Maintenanceand availability of certain records regarding employees and independentcontractors of certain agencies and facilities. Eachagency to provide personal care services in the home, agency to provide nursingin the home, facility for intermediate care, facility for skilled nursing andresidential facility for groups shall maintain accurate records of theinformation concerning its employees and independent contractors collectedpursuant to NRS 449.179, and shallmaintain a copy of the fingerprints submitted to the Central Repository forNevada Records of Criminal History and proof that it submitted two sets offingerprints to the Central Repository for its report. These records must bemade available for inspection by the Health Division at any reasonable time andcopies thereof must be furnished to the Health Division upon request.

(Added to NRS by 1997, 443; A 1999, 1947; 2005, 2171)

NRS 449.185 Terminationof employment or contract of employee or independent contractor of certainagency or facility who has been convicted of certain crime; liability of agencyor facility.

1. Upon receiving information from the CentralRepository for Nevada Records of Criminal History pursuant to NRS 449.179, or evidence from any othersource, that an employee or independent contractor of an agency to providepersonal care services in the home, an agency to provide nursing in the home, afacility for intermediate care, a facility for skilled nursing or a residentialfacility for groups has been convicted of a crime listed in paragraph (a) ofsubsection 1 of NRS 449.188, the administratorof, or the person licensed to operate, the agency or facility shall terminatethe employment or contract of that person after allowing him time to correctthe information as required pursuant to subsection 2.

2. If an employee or independent contractor believesthat the information provided by the Central Repository is incorrect, he mayimmediately inform the agency or facility. An agency or facility that is soinformed shall give the employee or independent contractor a reasonable amountof time of not less than 30 days to correct the information received from theCentral Repository before terminating the employment or contract of the personpursuant to subsection 1.

3. An agency or facility that has complied with NRS 449.179 may not be held civilly orcriminally liable based solely upon the ground that the agency or facilityallowed an employee or independent contractor to work:

(a) Before it received the information concerning theemployee or independent contractor from the Central Repository;

(b) During any period required pursuant to subsection 2to allow the employee or independent contractor to correct that information;

(c) Based on the information received from the CentralRepository, if the information received from the Central Repository wasinaccurate; or

(d) Any combination thereof.

An agency orfacility may be held liable for any other conduct determined to be negligent orunlawful.

(Added to NRS by 1997, 443; A 1999, 1948; 2005, 2171)

NRS 449.188 Denial,suspension or revocation of license to operate certain facility or agency:Conviction of applicant or licensee of certain crime or continued employment ofperson convicted of certain crime.

1. In addition to the grounds listed in NRS 449.160, the Health Division may deny alicense to operate a facility for intermediate care, facility for skillednursing or residential facility for groups to an applicant or may suspend orrevoke 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 commitsexual 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 contributorydelinquency;

(5) A violation of any federal or state lawregulating the possession, distribution or use of any controlled substance orany dangerous drug as defined in chapter 454of 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 ofproperty, within the immediately preceding 7 years; or

(8) Any other felony involving the use of afirearm or other deadly weapon, within the immediately preceding 7 years; or

(b) The licensee has continued to employ a person whohas 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 alicense to operate an agency to provide personal care services in the home oran agency to provide nursing in the home to an applicant or may suspend or revokethe license of a licensee to operate such an agency if the licensee hascontinued to employ a person who has been convicted of a crime listed inparagraph (a) of subsection 1.

(Added to NRS by 1997, 444; A 1999, 1948; 2005, 2171)

NRS 449.191 Medicalfacility not required to allow abortions.

1. A hospital or other medical facility licensed underthe provisions of this chapter which is not operated by the State or a localgovernment or an agency of either is not required to permit the use of itsfacilities for the induction or performance of an abortion, except in a medicalemergency.

2. Such refusal does not give rise to a cause ofaction in favor of any person.

(Added to NRS by 1973, 897; A 1985, 1742)

NRS 449.195 Waiverof deductible or copayment; conditions. Amedical facility shall not waive a deductible or copayment if:

1. The medical facility is not a preferred provider ofhealth care; and

2. The waiver would reduce the financial effect of apreferred providers incentive or disincentive to its insureds.

(Added to NRS by 1987, 1783; A 1995, 1602)

NRS 449.200 Disclosureof results of inspections of certain facilities. TheHealth Division shall, upon request, disclose to any person or governmentalentity the results of its inspections of facilities for skilled nursing,facilities for intermediate care and residential facilities for groupsregarding their compliance with applicable regulations and standards.

[14:336:1951](NRS A 1963, 961; 1971, 936; 1973,1285; 1987, 1054)

NRS 449.205 Medicalfacility prohibited from retaliating or discriminating against certain personsfor reporting or participating in investigation or proceeding relating tosentinel event or certain conduct of physician or reporting or refusing toprovide nursing services beyond his competence; restriction of rightprohibited.

1. A medical facility or any agent or employee thereofshall not retaliate or discriminate unfairly against:

(a) An employee of the medical facility or a personacting on behalf of the employee who in good faith:

(1) Reports to the Board of Medical Examiners orthe State Board of Osteopathic Medicine, as applicable, information relating tothe conduct of a physician which may constitute grounds for initiatingdisciplinary action against the physician or which otherwise raises areasonable question regarding the competence of the physician to practicemedicine with reasonable skill and safety to patients;

(2) Reports a sentinel event to the HealthDivision pursuant to NRS 439.835; or

(3) Cooperates or otherwise participates in aninvestigation or proceeding conducted by the Board of Medical Examiners, theState Board of Osteopathic Medicine or another governmental entity relating toconduct described in subparagraph (1) or (2).

(b) A registered nurse, licensed practical nurse ornursing assistant who is employed by or contracts to provide nursing servicesfor the medical facility and who, in accordance with the policy, if any,established by the medical facility:

(1) Reports to his immediate supervisor, inwriting, that he does not possess the knowledge, skill or experience to complywith an assignment to provide nursing services to a patient; and

(2) Refuses to provide to a patient nursingservices for which, as verified by documentation in the personnel file of theregistered nurse, licensed practical nurse or nursing assistant concerning hiscompetence to provide various nursing services, he does not possess theknowledge, skill or experience to comply with the assignment to provide nursingservices to the patient, unless such refusal constitutes unprofessional conductas set forth in chapter 632 of NRS or anyregulations adopted pursuant thereto.

2. A medical facility or any agent or employee thereofshall not retaliate or discriminate unfairly against an employee of the medicalfacility or a registered nurse, licensed practical nurse or nursing assistantwho is employed by or contracts to provide nursing services for the medicalfacility because the employee, registered nurse, licensed practical nurse ornursing assistant has taken an action described in subsection 1.

3. A medical facility or any agent or employee thereofshall not prohibit, restrict or attempt to prohibit or restrict by contract,policy, procedure or any other manner the right of an employee of the medicalfacility or a registered nurse, licensed practical nurse or nursing assistantwho is employed by or contracts to provide nursing services for the medicalfacility to take an action described in subsection 1.

4. As used in this section:

(a) Physician means a person licensed to practicemedicine pursuant to chapter 630 or 633 of NRS.

(b) Retaliate or discriminate:

(1) Includes, without limitation, the followingaction if such action is taken solely because the employee or the registerednurse, licensed practical nurse or nursing assistant took an action describedin subsection 1:

(I) Frequent or undesirable changes in thelocation where the employee works;

(II) Frequent or undesirable transfers orreassignments;

(III) The issuance of letters ofreprimand, 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 orworkdays.

(2) Does not include action described insub-subparagraphs (I) to (X), inclusive, of subparagraph (1) if the action istaken in the normal course of employment or as a form of discipline.

(Added to NRS by 2002 Special Session,16; A 2005, 1517)

NRS 449.207 Retaliationor discrimination in violation of NRS 449.205: Legal remedy. An employee of a medical facility or a registered nurse,licensed practical nurse or nursing assistant who is employed by or contractsto provide nursing services for the medical facility who believes that he hasbeen retaliated or discriminated against in violation of NRS 449.205 may file an action in a courtof competent jurisdiction for such relief as may be appropriate under the law.

(Added to NRS by 2002 Special Session,17; A 2005, 1518)

NRS 449.210 Penaltiesfor unlicensed operation: Medical facility or facility for dependent;residential facility for groups.

1. Except as otherwise provided in subsections 2 and3, a person who operates a medical facility or facility for the dependentwithout a license issued by the Health Division is guilty of a misdemeanor.

2. A person who operates a residential facility forgroups without a license issued by the Health Division:

(a) Is liable for a civil penalty to be recovered bythe Attorney General in the name of the Health Division for the first offenseof not more than $10,000 and for a second or subsequent offense of not lessthan $10,000 nor more than $20,000;

(b) Shall be required to move all of the persons whoare receiving services in the residential facility for groups to a residentialfacility for groups that is licensed at his own expense; and

(c) May not apply for a license to operate aresidential facility for groups for a period of 6 months after he is punishedpursuant to this section.

3. Unless otherwise required by federal law, theHealth Division shall deposit all civil penalties collected pursuant to thissection into a separate account in the State General Fund to be used for theprotection of the health, safety and well-being of patients, includingresidents of residential facilities for groups.

[10:336:1951](NRS A 1967, 581; 1971, 936; 1973,1285; 1985, 1742; 1999,3609)

NRS 449.220 Actionto enjoin violations.

1. The Health Division may bring an action in the nameof the State to enjoin any person, state or local government unit or agencythereof 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 bythe Health Division.

2. It is sufficient in such action to allege that thedefendant did, on a certain date and in a certain place, operate and maintainsuch facility without a license.

[Part 6:336:1951](NRS A 1963, 961; 1971, 937; 1973,1285)

NRS 449.230 Entryand inspection of building and premises.

1. Any authorized member or employee of the HealthDivision may enter and inspect any building or premises at any time to securecompliance 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, uponreceiving a request from the Health Division or a written complaint concerningcompliance with the plans and requirements to respond to an emergency adoptedpursuant to subsection 9 of NRS 449.037:

(a) Enter and inspect a residential facility forgroups; and

(b) Make recommendations regarding the adoption ofplans and requirements pursuant to subsection 9 of NRS 449.037,

to ensurethe safety of the residents of the facility in an emergency.

3. The State Health Officer or his designee shallenter and inspect at least annually each building or the premises of aresidential facility for groups to ensure compliance with standards for healthand sanitation.

4. An authorized member or employee of the HealthDivision shall enter and inspect any building or premises operated by aresidential facility for groups within 72 hours after the Health Division isnotified 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)

NRS 449.235 Inspectionof medical facility and facility for dependent by Health Division and AgingServices Division. Every medical facility orfacility for the dependent may be inspected at any time, with or withoutnotice, as often as is necessary by:

1. The Health Division to ensure compliance with allapplicable regulations and standards; and

2. Any person designated by the Aging ServicesDivision of the Department of Health and Human Services to investigatecomplaints made against the facility.

(Added to NRS by 1977, 642; A 1985, 1742; 1991, 1975;2001, 1343; 2003, 422)

NRS 449.240 Institutionand conduct of prosecutions. The district attorneyof the county in which the facility is located shall, upon application by theHealth Division, institute and conduct the prosecution of any action forviolation of any provisions of NRS 449.001to 449.245, inclusive.

[Part 8:336:1951](NRS A 1963, 962; 1971, 937; 1973,1286; 1975, 899)

MISCELLANEOUS PROVISIONS

NRS 449.243 Itemizedlist of charges required; use of Uniform Billing and Claims Forms authorized;contracted rates; summary of charges. Everyhospital 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 AmericanHospital Association.

2. Shall, except as otherwise provided in thissection, on its billings to patients, itemize, on a daily basis, all chargesfor services, and charges for equipment used and the supplies and medicinesprovided incident to the provision of those services with specificity and inlanguage that is understandable to an ordinary lay person. This itemized listmust be timely provided after the patient is discharged at no additional cost.

3. Except as otherwise provided in this subsection, ifa patient is charged a rate, pursuant to a contract or other agreement, that isdifferent than the billed charges, the hospital shall provide to the patienteither:

(a) A copy of the billing prepared pursuant tosubsection 2;

(b) A statement specifying the agreed rate for theservices; or

(c) If the patient is not obligated to pay any portionof the bill, a statement of the total charges.

In any case,the hospital shall include on the billing or statement any copayment ordeductible for which the patient is responsible. The hospital shall answer anyquestions regarding the bill.

4. If the hospital is paid by the insurer of a patienta rate that is based on the number of persons treated and not on the servicesactually rendered, the hospital shall, upon the discharge of the patient,advise the patient of the status of any copayment or deductible for which thepatient is responsible.

5. Shall prepare a summary of charges for commonservices for patients admitted to the hospital and make it available to thepublic.

6. Shall provide to any patient upon request a copy ofthe billing prepared pursuant to subsection 2.

(Added to NRS by 1975, 897; A 1983, 649; 1985, 905;1993, 2427; 1995, 1856)

NRS 449.244 Certaincosts for examination or treatment of victims of sexual offenses to be chargedto county.

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 forpossible prosecution of the person who committed the offense; or

(b) Initial emergency medical care for the victim,

must not becharged directly to the victim. The costs must be charged to the county inwhose jurisdiction the offense was committed.

2. Whenever costs are incurred by a hospital fortreatment which has been approved by the board of county commissioners pursuantto NRS 217.310 for the victim of a sexualassault and any other person eligible for treatment, the costs of thetreatment, not to exceed $1,000, must be charged to the county which authorizedthe treatment. Any remainder must be handled the same as other hospital costs.

(Added to NRS by 1975, 1133; A 1979, 587; 1985, 2106)

NRS 449.245 Releaseof child from hospital; provision of authorization for release and otherinformation to Division of Child and Family Services; disclosure ofinformation; penalty.

1. No hospital licensed under the provisions of NRS 449.001 to 449.240, inclusive, may release from thehospital or otherwise surrender physical custody of any child under 6 months ofage, whose living parent or guardian is known to the hospital, to any personother 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 themother if unwed, or guardian specifying the particular person or agency to whomthe child may be released and the permanent address of that person or agency.

2. Upon the release or other surrender of physicalcustody of the child, the hospital shall require from the person to whom thechild is released such reasonable proof of identity as the hospital may deemnecessary for compliance with the provisions of this section. The hospitalshall furnish a true copy of the written authorization to the Division of Childand Family Services of the Department of Health and Human Services before therelease or other surrender by it of physical custody of the child. The copymust be furnished to the Division immediately upon receipt by the hospital.

3. Any person to whom any such child is released whothereafter surrenders physical custody of that child to any other person oragency shall, upon demand by the Division of Child and Family Services,disclose to the Division the name and permanent address of the person or agencyto whom physical custody of the child was delivered.

4. All information received by the Division of Childand Family Services pursuant to the provisions of this section is confidentialand must be protected from disclosure in the same manner that information isprotected under NRS 432.035.

5. Compliance with the provisions of this section isnot a substitute for compliance with NRS127.220 to 127.310, inclusive,governing placements for adoption and permanent free care.

6. A violation of any provision of this section is amisdemeanor.

(Added to NRS by 1957, 251; A 1961, 739; 1963, 962;1967, 1172; 1973, 1286, 1406; 1981, 721; 1993, 2724)

NRS 449.246 Hospitalor obstetric center to provide information relating to voluntary acknowledgmentor establishment of paternity before discharging unmarried woman who has bornechild; regulations.

1. Before discharging an unmarried woman who has bornea child, a hospital or obstetric center shall provide to the childs mother andfather:

(a) The opportunity to sign, in the hospital, anaffidavit 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 andresponsibilities of acknowledging paternity; and

(e) The opportunity to speak by telephone withpersonnel of the program for enforcement of child support who are trained toclarify information and answer questions about the establishment of paternity.

2. The Administrator of the Division of Welfare andSupportive Services of the Department of Health and Human Services shall adoptthe regulations necessary to ensure that the services provided by a hospital orobstetric center pursuant to this section are in compliance with theregulations adopted by the Secretary of Health and Human Services pursuant to42 U.S.C. 666(a)(5)(C).

(Added to NRS by 1995, 2426; A 1997, 2341)

NRS 449.2465 Personsentitled to results of tests performed at laboratory regarding patient of ruralhospital. The following persons are entitledto access the results of tests performed at a licensed laboratory regarding apatient of a rural hospital:

1. The patient;

2. The physician who ordered the tests; and

3. A provider of health care who is currently treatingor providing assistance in the treatment of the patient.

(Added to NRS by 1995, 1600)

NRS 449.247 Nursingassistants and training of nursing assistants: Powers and duties of HealthDivision and State Board of Nursing; provision of information to State Board ofNursing.

1. The Health Division may review the personnel filesof a medical facility or facility for the dependent to determine that eachnursing assistant employed by the facility has a current certificate.

2. The Health Division shall review the qualificationsof instructors of nursing assistants for each program of which the Division isnotified pursuant to NRS 632.286.

3. The Health Division may conduct the review oftraining programs for nursing assistants in facilities for long-term care.

4. The Health Division and any other state agencywhich regulates medical facilities and facilities for the dependent shallprovide to the State Board of Nursing any information it discovers concerning:

(a) Programs and instructors for training nursingassistants which do not comply with the requirements established by the StateBoard of Nursing.

(b) The failure of a nursing assistant to performconsistently at a safe level.

(c) The results of any investigation of a facility ifthe investigation concerns a nursing assistant or instructor or trainingprogram for nursing assistants.

5. The State Board of Nursing shall investigate anyreport submitted pursuant to subsection 4 and may revoke approval of a programor instructor if the allegations of the report are true.

(Added to NRS by 1989, 2017)

NRS 449.248 Additionalservices to be provided by agency to provide nursing in home. An agency to provide nursing in the home shall, inaddition 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)

NRS 449.2485 Returnto dispensing pharmacy of unused prescription drug dispensed to patient offacility for skilled nursing or facility for intermediate care for purpose ofreissuing drug to fill other prescriptions for patients in facility.

1. A facility for skilled nursing or a facility forintermediate care may return a prescription drug that is dispensed to a patientof the facility, but will not be used by that patient, to the dispensingpharmacy for the purpose of reissuing the drug to fill other prescriptions forpatients in that facility if:

(a) The drug is not a schedule II drug specified in orpursuant to chapter 453 of NRS;

(b) The drug is dispensed in a unit dose, inindividually sealed doses or in a bottle sealed by the manufacturer of thedrug;

(c) The drug is returned unopened and sealed in theoriginal manufacturers packaging or bottle;

(d) The usefulness of the drug has not expired;

(e) The packaging or bottle contains the expirationdate of the usefulness of the drug; and

(f) The name of the patient for whom the drug wasoriginally prescribed, the prescription number and any other identifying marksare obliterated from the packaging or bottle before the return of the drug.

2. A dispensing pharmacy to which a drug is returnedpursuant to this section may reissue the drug to fill other prescriptions forpatients in the same facility if the registered pharmacist of the pharmacydetermines that the drug is suitable for that purpose in accordance withstandards adopted by the State Board of Pharmacy pursuant to subsection 5.

3. No drug that is returned to a dispensing pharmacypursuant to this section may be used to fill other prescriptions more than onetime.

4. A facility for skilled nursing or facility forintermediate care shall adopt written procedures for returning drugs to adispensing pharmacy pursuant to this section. The procedures must:

(a) Provide appropriate safeguards for ensuring thatthe drugs are not compromised or illegally diverted during their return.

(b) Require the maintenance and retention of suchrecords relating to the return of drugs to dispensing pharmacies as arerequired by the State Board of Pharmacy.

(c) Be approved by the State Board of Pharmacy.

5. The State Board of Pharmacy shall adopt suchregulations as are necessary to carry out the provisions of this section,including, without limitation, requirements for:

(a) Returning and reissuing such drugs pursuant to theprovisions of this section.

(b) Maintaining records relating to the return and theuse of such drugs to fill other prescriptions.

(Added to NRS by 2003, 1372)

HOMES FOR INDIVIDUAL RESIDENTIAL CARE

NRS 449.249 Licenserequired for operation of home; application for license; minimal standards forlicensing.

1. A person,state or local government or agency thereof shall not operate a home forindividual residential care without first obtaining a license for the home fromthe Health Division. An application for the license must be made in the mannerprovided in NRS 449.040.

2. The State Board of Health shall adopt minimalstandards for licensing that provide for care and sanitation to prevent theabuse, neglect or exploitation of residents of homes for individual residentialcare.

(Added to NRS by 1993, 2556; A 1999, 1050)

NRS 449.2493 Authorityof Health Division and Aging Services Division of Department of Health andHuman Services. The Health Division and theAging Services Division of the Department of Health and Human Services may:

1. Investigate any complaints against a home forindividual residential care and, when conducting such an investigation, mayinspect the home during normal business hours, with or without notice.

2. Report to an appropriate state or local agency anyviolations of state or local laws or regulations discovered during aninvestigation conducted pursuant to this section.

(Added to NRS by 1993, 2556)

NRS 449.2496 Penaltiesfor unlicensed operation or maintenance of home.

1. A person who operates or maintains a home forindividual residential care without a license issued by the Health Divisionpursuant to NRS 449.249 is liable for acivil penalty, to be recovered by the Attorney General in the name of theHealth Division, for the first offense of $10,000 and for a second orsubsequent offense of not less than $10,000 nor more than $20,000.

2. Unless otherwise required by federal law, theHealth Division shall deposit civil penalties collected pursuant to thissection into a separate account in the State General Fund in the State Treasuryto be used for the protection of the health, safety, well-being and property ofpatients, including residents of facilities found deficient by the HealthDivision.

3. A person against whom a civil penalty is assessedby the court pursuant to subsection 1:

(a) Shall move, at his own expense, all personsreceiving services in the home for individual residential care to a licensedhome for individual residential care.

(b) May not apply for a license to operate a home forindividual residential care until 6 months have elapsed since the penalty wasassessed.

(Added to NRS by 1993, 2556; A 1999, 1051)

NEVADA HEALTH FACILITIES ASSISTANCE ACT

NRS 449.250 Shorttitle. NRS449.250 to 449.430, inclusive, maybe cited as the Nevada Health Facilities Assistance Act.

[1:219:1949; 1943 NCL 5285.01](NRS A 1965, 983)

NRS 449.260 Definitions. As used in NRS 449.250to 449.430, inclusive:

1. Community mental health center means a facilityproviding services for the prevention or diagnosis of mental illness, or careand treatment of mentally ill patients, or rehabilitation of such persons,which services are provided principally for persons residing in a particularcommunity in or near which the facility is situated.

2. Construction includes the construction of newbuildings, modernization, expansion, remodeling and alteration of existingbuildings, and initial equipment of such buildings, including medicaltransportation facilities, and includes architects fees, but excludes the costof off-site improvements and, except with respect to public health centers, thecost of the acquisition of the land.

3. Facility for the mentally retarded means afacility specially designed for the diagnosis, treatment, education, trainingor custodial care of the mentally retarded, including facilities for trainingspecialists and sheltered workshops for the mentally retarded, but only if suchworkshops are part of facilities which provide or will provide comprehensiveservices 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 foror 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 toadminister 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 withphysical or mental impairments, including diagnostic or diagnostic andtreatment centers, rehabilitation facilities and nursing homes, as those termsare defined in the Federal Act, and such other facilities for which federal aidmay be authorized under the Federal Act, but, except for facilities for thementally retarded, does not include any facility furnishing primarilydomiciliary care.

7. Nonprofit health facility means any healthfacility owned and operated by a corporation or association, no part of the netearnings of which inures or may lawfully inure to the benefit of any privateshareholder or natural person.

8. Public health center means a publicly ownedfacility for the provision of public health services, including related facilitiessuch as laboratories, clinics and administrative offices operated in connectionwith public health centers.

9. State Department means the Department of Healthand 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)

NRS 449.270 StateDepartment to constitute sole agency of State for certain purposes. The State Department shall constitute the sole agency ofthe State for the purpose of:

1. Inventorying existing health facilities, surveyingthe need for construction of health facilities, and developing programs ofhealth facilities construction as provided in NRS449.250 to 449.430, inclusive.

2. Developing and administering state plans for theconstruction of public and other nonprofit health facilities as provided in NRS 449.250 to 449.430, inclusive.

3. Developing and administering any other plan orprogram providing assistance to health facilities for which funds may beavailable to this state under the Federal Act.

[3:219:1949; 1943 NCL 5285.03](NRS A 1965, 985)

NRS 449.280 Dutiesof State Department. In carrying out thepurposes of NRS 449.250 to 449.430, inclusive, the State Department isauthorized and directed:

1. To require such reports, make such inspections andinvestigations, and prescribe such regulations as it deems necessary.

2. To provide such methods of administration, appointall necessary officers and other personnel and take such other action as may benecessary to comply with the requirements of NRS449.250 to 449.430, inclusive, theFederal Act and the regulations thereunder.

3. To procure in its discretion the temporary orintermittent services of experts or consultants, by contract, when suchservices are to be performed on a part-time or fee-for-service basis and do notinvolve the performance of administrative duties.

4. To the extent that it considers desirable toeffectuate the purposes of NRS 449.250to 449.430, inclusive, to enter intoagreements for the utilization of the facilities and services of otherdepartments, agencies and institutions, public or private.

5. To accept on behalf of the State and to depositwith the State Treasurer in appropriate accounts in the Department of Healthand Human Services Gift Fund any grant, gift or contribution made to assist inmeeting the cost of carrying out the purposes of NRS 449.250 to 449.430, inclusive, and to expend the samefor such purposes.

6. To do all other things on behalf of the Statenecessary or advisable to obtain the maximum benefits available under theFederal Act.

7. All claims must be approved by the Health Officerbefore they are paid.

[4:219:1949; 1943 NCL 5285.04](NRS A 1965, 985;1969, 945; 1981, 79)

NRS 449.300 Inventoryof existing health facilities; development of program for construction offacilities. The State Department is authorizedand directed to inventory existing health facilities, including public,nonprofit, and proprietary health facilities, to survey the need forconstruction of health facilities, and, on the basis of such inventory andsurvey, to develop programs for the construction of such public and othernonprofit health facilities as will, in conjunction with existing facilities,afford the necessary physical facilities for furnishing adequate healthfacility services to all the people of the State.

[7:219:1949; 1943 NCL 5285.07](NRS A 1965, 986)

NRS 449.310 Requirementsof program for construction of health facilities. Theconstruction programs must provide, in accordance with NRS 449.250 to 449.430, inclusive, and the regulationsthereunder, for adequate health facilities for the people residing in thisState, and, insofar as possible, must provide for their distribution throughoutthe State in such manner as to make the services of all types of healthfacilities reasonably accessible to all persons in the State.

[9:219:1949; 1943 NCL 5285.09](NRS A 1965, 986;1981, 1901)

NRS 449.320 Applicationfor federal money; deposit of money.

1. The State Department may apply to the federalagency for federal money to assist in carrying out the surveys, planning andconstruction activities provided for in NRS449.250 to 449.430, inclusive.

2. The money must be deposited in the State Treasuryand must be available to the State Department for expenditure for carrying outthe purposes of NRS 449.250 to 449.430, inclusive.

[8:219:1949; 1943 NCL 5285.08](NRS A 1965, 987;1981, 1901)

NRS 449.340 StateDepartment to prescribe minimum standards; standards to supersede localordinances and regulations; penalty.

1. The State Department may, by regulation, establishstandards for the maintenance and operation of health facilities, which supersedeall local ordinances and regulations inconsistent therewith.

2. A copy of the regulations, giving the date thatthey take effect, must be issued in pamphlet form.

3. Any health facility that applies for and acceptsfederal aid for construction under a state plan does so on the condition thatthe health facility qualify under the minimum standards for maintenance andoperation adopted and enforced by the State Department.

4. Any person, partnership, association or corporationestablishing, conducting, managing or operating any health facility within themeaning of NRS 449.250 to 449.430, inclusive, who violates any of theprovisions of this section or regulations lawfully adopted thereunder is guiltyof 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)

NRS 449.360 Applicationfor construction of health facility: Filing; compliance with federal and staterequirements.

1. Applications for health facility constructionprojects for which federal funds are required must be submitted to theappropriate health systems agency and the State Department. They may besubmitted by the State or any political subdivision thereof or by any public ornonprofit agency authorized to construct and operate a health facility.

2. Each application for a construction project mustconform to federal and state requirements and must be submitted in the mannerand form prescribed by the State Department.

[14:219:1949; 1943 NCL 5285.14](NRS A 1965, 988;1979, 969)

NRS 449.370 Applicationfor construction of health facility: Notice and hearing; approval andforwarding.

1. The State Department shall afford to everyapplicant for assistance for a construction project an opportunity for a fairhearing before the State Department upon 10 days written notice to theapplicant.

2. If the State Department, after affording reasonableopportunity for development and presentation of applications in the order ofrelative need, finds that an application is in conformity with the state plan,the State Department shall approve the application and shall recommend andforward it to the federal agency.

3. The State Department shall consider and forwardapplications 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)

NRS 449.380 Inspectionof construction of health facility; certification by State Department. From time to time, the State Department shall inspect eachconstruction project approved by the federal agency and, if the inspection sowarrants, the State Department shall certify to the federal agency that workhas been performed upon the project, or that purchases have been made, inaccordance with the approved plans and specifications, and that payment of aninstallment of federal funds is due to the applicant.

[16:219:1949; 1943 NCL 5285.16](NRS A 1965, 988)

NRS 449.390 Authorityto receive and distribute federal money; Health Facilities Assistance Fund;deposits, use and controls.

1. The State Department is hereby authorized toreceive federal funds in behalf of, and transmit them to, applicants.

2. There is hereby established a nonreverting trustfund designated as the Health Facilities Assistance Fund. Money received fromthe Federal Government for a construction project approved by the federalagency shall be transmitted to the State Treasurer to be deposited in the StateTreasury to the credit of the Health Facilities Assistance Fund, and shall beused solely for payments due applicants for work performed, purchases made orother approved expenditures in carrying out approved projects or plans, exceptthat any moneys in such Fund which become available under the Federal Act andregulations for expenditure in administering an approved state plan may beexpended for that purpose.

3. The State Department shall establish and maintainsuch accounts and fiscal controls of moneys deposited in and disbursed from theHealth Facilities Assistance Fund as may be required by the Federal Act andregulations promulgated thereunder.

[17:219:1949; 1943 NCL 5285.17](NRS A 1965, 988;1975, 259)

NRS 449.400 StatePublic Health Facilities Construction Assistance Fund: Creation;administration.

1. In order to provide state assistance forconstruction projects for publicly owned general hospitals, hospitals for thechronically ill and impaired, facilities for the mentally retarded, communitymental health facilities, diagnostic or diagnostic and treatment centers,rehabilitation facilities, nursing homes and other facilities financed in partby federal funds in accordance with NRS449.250 to 449.430, inclusive, andto promote maximum utilization of federal funds available for such projects,there is hereby created in the State Treasury a nonreverting trust fund to beknown as the State Public Health Facilities Construction Assistance Fund. Moneyfor the Fund may be provided from time to time by legislative appropriation.

2. The State Public Health Facilities ConstructionAssistance Fund must be administered by the State Department in accordance withthe purposes and provisions of NRS 449.250to 449.430, inclusive.

[17.1:219:1949; added 1956, 47](NRS A 1965, 989;1985, 1744)

NRS 449.410 Stateassistance for construction of certain projects; eligibility of project forassistance.

1. Money in the State Public Health FacilitiesConstruction Assistance Fund must be used to supplement money from the FederalGovernment and money provided by the sponsor of a project for approved projectsfor the construction of publicly owned general hospitals, hospitals for thechronically ill or impaired, facilities for the mentally retarded, communitymental health facilities, diagnostic or diagnostic and treatment centers,rehabilitation facilities, nursing homes and other facilities financed in partby federal funds pursuant to NRS 449.250to 449.430, inclusive, and for no otherpurpose or purposes.

2. Applications for state assistance for constructionprojects must be submitted to the State Department for consideration in themanner prescribed in NRS 449.250 to 449.430, inclusive, for applications forfederal assistance.

3. No project is entitled to receive state assistanceunless it is entitled to receive federal assistance.

[17.2:219:1949; added 1956, 47](NRS A 1965, 989;1985, 1744)

NRS 449.420 Amountof state assistance: Allocations; payments. Moneyin the State Public Health Facilities Construction Assistance Fund must beallocated and paid to construction projects on the basis of relative need inaccordance with the need identified in the state health plan and in accordancewith a ratio between state money and federal money determined by the StateDepartment. In no event may the amount of state assistance made available orpaid out for a project exceed the amount supplied by the sponsor of theproject.

[17.3:219:1949; added 1956, 47](NRS A 1965, 989; 1981,856, 1901)

NRS 449.430 Moneyfrom State Public Health Facilities Construction Assistance Fund to be paid ininstallments. Moneys in the State PublicHealth Facilities Construction Assistance Fund allocated to a particularapproved project shall be paid out in installments at the same times and in thesame manner as installments of federal funds are paid out from the HealthFacilities Assistance Fund pursuant to NRS449.390.

[17.4:219:1949; added 1956, 47](NRS A 1965, 990)

ACCOUNTING; FINANCIAL REPORTS; FEES; ENSURING QUALITY OFCARE

NRS 449.450 Definitions. As used in NRS 449.450to 449.530, inclusive, unless thecontext otherwise requires:

1. Admitted health insurer means an insurerauthorized to transact health insurance in this State under a certificate ofauthority issued by the Commissioner of Insurance.

2. Department means the Department of Health andHuman Services.

3. Director means the Director of the Department.

4. Institution means any person, place, building oragency which maintains and operates facilities for the diagnosis, care andtreatment of human illness and provides beds for inpatient care. The termincludes but is not limited to hospitals, convalescent care facilities, nursingcare facilities, detoxification centers and all specialized medical health carefacilities.

(Added to NRS by 1975, 702; A 1979, 887; 1983, 1127;1985, 1362; 1989, 1800; 1991, 2114)

NRS 449.460 Powersof Director. The Director may:

1. Adopt regulations respecting the exercise of thepowers conferred by NRS 449.450 to 449.530, inclusive.

2. Hold public hearings, conduct investigations andrequire the filing of information relating to any matter affecting the cost ofservices 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 orderrequiring the filing of information or a subpoena issued pursuant to thissubsection must state the purpose for which it is issued. The Director may alsoadminister oaths in any hearing or investigation.

3. Exercise, subject to the limitations andrestrictions imposed in NRS 449.450 to 449.530, inclusive, all other powers whichare reasonably necessary to carry out the expressed objects of those sections.

4. Delegate to any of the divisions of the Departmentthe authority to carry out the provisions of NRS449.450 to 449.530, inclusive.

(Added to NRS by 1975, 702; A 1985, 1363; 1991, 2114;1997, 2527)

NRS 449.465 Authorityof Director to impose fees; maximum amount of fees collected; fee for supportof Legislative Committee on Health Care.

1. The Director may, by regulation, impose fees uponadmitted health insurers to cover the costs of carrying out the provisions of NRS 449.450 to 449.530, inclusive. The maximum amount offees collected must not exceed the amount authorized by the Legislature in eachbiennial budget.

2. The Director shall impose a fee of $50 each yearupon admitted health insurers for the support of the Legislative Committee onHealth Care. The fee imposed pursuant to this subsection is in addition to anyfee imposed pursuant to subsection 1. The fee collected for the support of theLegislative Committee on Health Care must be deposited in the Legislative Fund.

(Added to NRS by 1983, 1126; A 1985, 1363; 1987, 877)

NRS 449.470 Directormay use staff or contract for services. Incarrying out the duties prescribed by NRS449.450 to 449.530, inclusive, theDirector may utilize his own staff or may contract with any appropriate,independent and qualified organization. Such a contractor shall not release orpublish or otherwise use any information made available to it under itscontractual responsibility unless permission is specifically granted by theDirector.

(Added to NRS by 1975, 703; A 1985, 1363)

NRS 449.476 Committeeto ensure quality of care: Formation by hospital; general requirements.

1. Each hospital licensed to operate in this stateshall 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 andnurses.

2. Each committee formed pursuant to subsection 1 mustmeet the requirements for programs or plans for ensuring the quality of carespecified by the Joint Commission on Accreditation of Healthcare Organizationsor 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)

NRS 449.485 Hospitalrequired to use form for all patients discharged; regulations; hospitals with morethan 100 beds to provide information on magnetic tape or by other means;exemption.

1. Each hospital in this State shall use for allpatients discharged the form commonly referred to as the UB-82, or adifferent form prescribed by the Director with the approval of a majority ofthe hospitals licensed in this State, and shall include in the form allinformation required by the Department.

2. The Department shall by regulation:

(a) Specify the information required to be included inthe form for each patient; and

(b) Require each hospital to provide specifiedinformation from the form to the Department.

3. Each insurance company or other payer shall acceptthe form as the bill for services provided by hospitals in this State.

4. Except as otherwise provided in subsection 5, eachhospital with 100 or more beds shall provide the information required pursuantto paragraph (b) of subsection 2 on magnetic tape or by other means specifiedby the Department, or shall provide copies of the forms and pay the costs ofentering the information manually from the copies.

5. The Director may exempt a hospital from therequirements of subsection 4 if requiring the hospital to comply with therequirements would cause the hospital financial hardship.

(Added to NRS by 1987, 875; A 2005, 1736)

NRS 449.490 Financialstatements and reports required to be filed with Department; additionalreporting requirements for hospitals with 100 or more beds.

1. Every institution which is subject to theprovisions of NRS 449.450 to 449.530, inclusive, shall file with theDepartment the following financial statements or reports in a form and atintervals specified by the Director but at least annually:

(a) A balance sheet detailing the assets, liabilitiesand net worth of the institution for its fiscal year; and

(b) A statement of income and expenses for the fiscalyear.

2. Each hospital with 100 or more beds shall file withthe Department, in a form and at intervals specified by the Director but atleast annually, a capital improvement report which includes, withoutlimitation, any major service line that the hospital has added or is in theprocess of adding since the previous report was filed, any major expansion ofthe existing facilities of the hospital that has been completed or is in theprocess of being completed since the previous report was filed, and any majorpiece of equipment that the hospital has acquired or is in the process of acquiringsince the previous report was filed.

3. In addition to the information required to be filedpursuant to subsections 1 and 2, each hospital with 100 or more beds shall filewith the Department, in a form and at intervals specified by the Director butat least annually:

(a) The corporate home office allocation methodology ofthe hospital, if any.

(b) The expenses that the hospital has incurred forproviding community benefits and the in-kind services that the hospital hasprovided to the community in which it is located. For the purposes of thisparagraph, community benefits includes, without limitation, goods, servicesand resources provided by a hospital to a community to address the specificneeds and concerns of that community, services provided by a hospital to theuninsured and underserved persons in that community, training programs foremployees in a community and health care services provided in areas of acommunity that have a critical shortage of such services, for which thehospital does not receive full reimbursement.

(c) A statement of its policies and procedures forproviding discounted services to, or reducing charges for services provided to,persons without health insurance that are in addition to any reduction ordiscount required to be provided pursuant to NRS 439B.260.

(d) A statement of its policies regarding patientsaccount receivables, including, without limitation, the manner in which ahospital collects or makes payment arrangements for patients accountreceivables, the factors that initiate collections and the method by whichunpaid account receivables are collected.

4. A complete current charge master must be availableat each hospital during normal business hours for review by the Director, anypayor that has a contract with the hospital to pay for services provided by thehospital, any payor that has received a bill from the hospital and any stateagency that is authorized to review such information.

5. The Director shall require the certification ofspecified financial reports by an independent certified public accountant andmay require attestations from responsible officers of the institution that thereports are, to the best of their knowledge and belief, accurate and completeto the extent that the certifications and attestations are not required byfederal law.

6. The Director shall require the filing of allreports by specified dates, and may adopt regulations which assess penaltiesfor failure to file as required, but he shall not require the submission of afinal annual report sooner than 6 months after the close of the fiscal year,and may grant extensions to institutions which can show that the requiredinformation is not available on the required reporting date.

7. All reports, except privileged medical information,filed under any provisions of NRS 449.450to 449.530, inclusive, are open topublic inspection and must be available for examination at the office of theDepartment during regular business hours.

(Added to NRS by 1975, 702; A 1985, 1364; 1987, 877; 2005, 1737)

NRS 449.500 Directorto carry out analyses and studies concerning cost of health care. The Director shall engage in or carry out analyses andstudies relating to the cost of health care in Nevada and other states, thefinancial status of any institution subject to the provisions of NRS 449.450 to 449.530, inclusive, and any otherappropriate related matters, and he may publish and disseminate any informationrelating to the financial aspects of health care as he deems desirable in thepublic interest and in accordance with the provisions of NRS 449.450 to 449.530, inclusive. He shall furtherrequire the filing of information concerning the total financial needs of eachinstitution and the resources available or expected to become available to meetsuch needs, including but not limited to the effect of proposals made by comprehensiveareawide and state health planning agencies. The information must be dividedinto at least the following components of an institutions expenses:

1. Operating expenses related to patient care.

2. Expenses incurred for rendering services topatients for whom payment is not made in full including, but not limited to,the separate expenses for contractual allowances imposed by federal or statelaw, charity care and uncollectible accounts.

3. All incurred interest charges on indebtedness forboth 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 andequipment.

7. Amortization of incurred capital and operating relatedindebtedness.

8. Requirements for capital expenditures forreplacement, modernization, renovation and expansion of services andfacilities.

9. Requirements for necessary working capital,including but not limited to operating cash, patients accounts receivable andinventories.

10. Federal, state and local taxes not ordinarilyconsidered operating expenses where applicable.

11. Operating surpluses necessary for a fair return totheir 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)

NRS 449.510 Directorto prepare and file summaries, compilations or other reports; publicinspection; collection, maintenance, disclosure or publication of contracts oridentification of party to contract prohibited.

1. The Director shall prepare and file such summaries,compilations or other supplementary reports based on the information filed withhim pursuant to NRS 449.450 to 449.530, inclusive, as will advance thepurposes of those sections. All such summaries, compilations and reports areopen to public inspection, must be made available to requesting agencies andmust be prepared within a reasonable time following the end of eachinstitutions 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, orcollect, maintain, disclose, report or publish information pursuant to thissection in a manner that would allow identification of an individual payer orother party to a contract with the hospital, except that the Director maydisclose to other state agencies the details of contracts between the hospitaland a related entity. A state agency shall not collect, maintain, disclose,report or publish information disclosed to the agency by the Director pursuantto this subsection in a manner that would allow identification of an individualpayer or other party to a contract with the hospital. The Director may reviewany such contracts at the hospital or at a location specified by the hospital.

3. As used in this section, related entity means anaffiliated 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)

NRS 449.520 Reportto Governor, Legislative Committee on Health Care and Interim FinanceCommittee; contents; Legislative Committee on Health Care to developcomprehensive plan concerning provision of health care.

1. On or before October 1 of each year, the Directorshall prepare and transmit to the Governor, the Legislative Committee on HealthCare and the Interim Finance Committee a report of the Departments operationsand activities for the preceding fiscal year.

2. The report prepared pursuant to subsection 1 mustinclude:

(a) Copies of all summaries, compilations andsupplementary reports required by NRS449.450 to 449.530, inclusive,together with such facts, suggestions and policy recommendations as theDirector deems necessary;

(b) A summary of the trends of the audits of hospitalsin this State that the Department required or performed during the previousyear;

(c) An analysis of the trends in the costs, expensesand profits of hospitals in this State;

(d) An analysis of the corporate home office allocationmethodologies of hospitals in this State;

(e) An examination and analysis of the manner in whichhospitals are reporting the information that is required to be filed pursuantto NRS 449.490, including, withoutlimitation, an examination and analysis of whether that information is beingreported in a standard and consistent manner, which fairly reflect theoperations of each hospital;

(f) A review and comparison of the policies andprocedures used by hospitals in this State to provide discounted services to,and to reduce charges for services provided to, persons without healthinsurance; and

(g) A review and comparison of the policies andprocedures used by hospitals in this State to collect unpaid charges forservices provided by the hospitals.

3. The Legislative Committee on Health Care shalldevelop a comprehensive plan concerning the provision of health care in thisState which includes, without limitation:

(a) A review of the health care needs in this State asidentified by state agencies, local governments, providers of health care andthe general public; and

(b) A review of the capital improvement reportssubmitted by hospitals pursuant to subsection 2 of NRS 449.490.

(Added to NRS by 1975, 704; A 1983, 1127; 1985, 1365;2005, 1738)

NRS 449.530 Administrativefine for violation. The Director may imposeupon the institutions subject to supervision under NRS 449.450 to 449.530, inclusive, an administrative finenot 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

NRS 449.535 Shorttitle; uniformity of application and construction.

1. NRS 449.535to 449.690, inclusive, may be cited asthe Uniform Act on Rights of the Terminally Ill.

2. NRS 449.535to 449.690, inclusive, must be appliedand construed to effectuate its general purpose to make uniform the law withrespect to the subject of those sections among states enacting the Uniform Acton Rights of the Terminally Ill.

(Added to NRS by 1991, 629)

NRS 449.540 Definitions. As used in NRS 449.535to 449.690, inclusive, unless thecontext otherwise requires, the words and terms defined in NRS 449.550 to 449.590, inclusive, have the meaningsascribed to them in those sections.

(Added to NRS by 1977, 759; A 1991, 632)

NRS 449.550 Attendingphysician defined. Attending physicianmeans the physician who has primary responsibility for the treatment and careof the patient.

(Added to NRS by 1977, 759; A 1991, 632)

NRS 449.560 Declarationdefined. Declaration means a writing executedin accordance with the requirements of NRS449.600.

(Added to NRS by 1977, 759; A 1991, 632)

NRS 449.570 Life-sustainingtreatment defined. Life-sustaining treatmentmeans 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)

NRS 449.575 Persondefined. Person includes a government or agovernmental subdivision or agency.

(Added to NRS by 1991, 629)

NRS 449.581 Providerof health care defined. Provider of healthcare means a person who is licensed, certified or otherwise authorized by thelaw of this state to administer health care in the ordinary course of businessor practice of a profession.

(Added to NRS by 1991, 629)

NRS 449.585 Qualifiedpatient defined. Qualified patient means apatient 18 or more years of age who has executed a declaration and who has beendetermined by the attending physician to be in a terminal condition.

(Added to NRS by 1991, 629)

NRS 449.590 Terminalcondition defined. Terminal condition meansan incurable and irreversible condition that, without the administration oflife-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)

NRS 449.600 Declarationrelating to use of life-sustaining treatment.

1. A person of sound mind and 18 or more years of agemay execute at any time a declaration governing the withholding or withdrawalof life-sustaining treatment. The declarant may designate another naturalperson of sound mind and 18 or more years of age to make decisions governingthe withholding or withdrawal of life-sustaining treatment. The declarationmust be signed by the declarant, or another at the declarants direction, andattested by two witnesses.

2. A physician or other provider of health care who isfurnished a copy of the declaration shall make it a part of the declarantsmedical record and, if unwilling to comply with the declaration, promptly soadvise the declarant and any person designated to act for the declarant.

(Added to NRS by 1977, 759; A 1985, 1747; 1991, 633)

NRS 449.610 Formof declaration directing physician to withhold or withdraw life-sustainingtreatment. A declaration directing a physicianto withhold or withdraw life-sustaining treatment may, but need not, be in thefollowing form:

 

DECLARATION

 

If I should have an incurable and irreversible conditionthat, without the administration of life-sustaining treatment, will, in theopinion of my attending physician, cause my death within a relatively shorttime, and I am no longer able to make decisions regarding my medical treatment,I direct my attending physician, pursuant to NRS449.535 to 449.690, inclusive, towithhold or withdraw treatment that only prolongs the process of dying and isnot 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 ofartificial nutrition and hydration may result in death by starvation or dehydration.Initial this box if you want to receive or continue receiving artificialnutrition and hydration by way of the gastrointestinal tract after all othertreatment 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)

NRS 449.613 Formof declaration designating another person to decide to withhold or withdrawlife-sustaining treatment.

1. A declaration that designates another person tomake decisions governing the withholding or withdrawal of life-sustainingtreatment may, but need not, be in the following form:

 

DECLARATION

 

If I should have an incurable and irreversible conditionthat, without the administration of life-sustaining treatment, will, in theopinion of my attending physician, cause my death within a relatively shorttime, and I am no longer able to make decisions regarding my medical treatment,I appoint ............................... or, if he or she is not reasonablyavailable or is unwilling to serve, .............................., to makedecisions on my behalf regarding withholding or withdrawal of treatment thatonly prolongs the process of dying and is not necessary for my comfort or toalleviate pain, pursuant to NRS 449.535to 449.690, inclusive. (If the person orpersons I have so appointed are not reasonably available or are unwilling toserve, I direct my attending physician, pursuant to those sections, to withholdor withdraw treatment that only prolongs the process of dying and is notnecessary 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 ofartificial nutrition and hydration may result in death by starvation or dehydration.Initial this box if you want to receive or continue receiving artificialnutrition and hydration by way of the gastrointestinal tract after all othertreatment 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 judicialappointment of a guardian, who is authorized to make decisions regarding thewithholding or withdrawal of life-sustaining treatment, constitutes for thepurpose of NRS 449.535 to 449.690, inclusive, a declaration designatinganother person to act for the declarant pursuant to subsection 1.

(Added to NRS by 1991, 630; A 1993, 2791)

NRS 449.617 Timedeclaration becomes operative; duty of providers of health care. A declaration becomes operative when it is communicated tothe attending physician and the declarant is determined by the attendingphysician to be in a terminal condition and no longer able to make decisionsregarding administration of life-sustaining treatment. When the declarationbecomes operative, the attending physician and other providers of health careshall act in accordance with its provisions and with the instructions of aperson designated pursuant to NRS 449.600or comply with the requirements of NRS449.628 to transfer care of the declarant.

(Added to NRS by 1991, 631)

NRS 449.620 Revocationof declaration; entry of revocation in medical records of declarant.

1. A declarant may revoke a declaration at any timeand in any manner, without regard to his mental or physical condition. Arevocation is effective upon its communication to the attending physician orother provider of health care by the declarant or a witness to the revocation.

2. The attending physician or other provider of healthcare shall make the revocation a part of the declarants medical record.

(Added to NRS by 1977, 760; A 1987, 1309; 1991, 635)

NRS 449.622 Recordingdetermination of terminal condition and declaration. Upondetermining that a declarant is in a terminal condition, the attendingphysician who knows of a declaration shall record the determination, and theterms of the declaration if not already a part of the record, in thedeclarants medical record.

(Added to NRS by 1991, 631)

NRS 449.624 Treatmentof qualified patients; withholding or withdrawal of artificial nutrition andhydration; treatment of pregnant patient.

1. A qualified patient may make decisions regardinglife-sustaining treatment so long as he is able to do so.

2. NRS 449.535to 449.690, inclusive, do not affect theresponsibility of the attending physician or other provider of health care toprovide treatment for a patients comfort or alleviation of pain.

3. Artificial nutrition and hydration by way of thegastrointestinal tract shall be deemed a life-sustaining treatment and must bewithheld or withdrawn from a qualified patient unless a different desire isexpressed in writing by the patient. For a patient who has no effectivedeclaration, artificial nutrition and hydration must not be withheld unless adifferent desire is expressed in writing by his authorized representative orthe family member with the authority to consent or withhold consent.

4. Life-sustaining treatment must not be withheld orwithdrawn pursuant to a declaration from a qualified patient known to theattending physician to be pregnant so long as it is probable that the fetuswill develop to the point of live birth with continued application oflife-sustaining treatment.

(Added to NRS by 1991, 631)

NRS 449.626 Writtenconsent to withhold or withdraw life-sustaining treatment.

1. If written consent to the withholding or withdrawalof the treatment, attested by two witnesses, is given to the attendingphysician, the attending physician may withhold or withdraw life-sustainingtreatment from a patient who:

(a) Has been determined by the attending physician tobe in a terminal condition and no longer able to make decisions regardingadministration of life-sustaining treatment; and

(b) Has no effective declaration.

2. The authority to consent or to withhold consentunder subsection 1 may be exercised by the following persons, in order ofpriority:

(a) The spouse of the patient;

(b) An adult child of the patient or, if there is morethan one adult child, a majority of the adult children who are reasonablyavailable for consultation;

(c) The parents of the patient;

(d) An adult sibling of the patient or, if there ismore than one adult sibling, a majority of the adult siblings who arereasonably available for consultation; or

(e) The nearest other adult relative of the patient byblood or adoption who is reasonably available for consultation.

3. If a class entitled to decide whether to consent isnot reasonably available for consultation and competent to decide, or declinesto decide, the next class is authorized to decide, but an equal division in aclass does not authorize the next class to decide.

4. A decision to grant or withhold consent must bemade in good faith. A consent is not valid if it conflicts with the expressedintention of the patient.

5. A decision of the attending physician acting ingood faith that a consent is valid or invalid is conclusive.

6. Life-sustaining treatment must not be withheld orwithdrawn pursuant to this section from a patient known to the attending physicianto be pregnant so long as it is probable that the fetus will develop to thepoint of live birth with continued application of life-sustaining treatment.

(Added to NRS by 1991, 631)

NRS 449.628 Transferof care of declarant. An attending physician orother provider of health care who is unwilling to comply with NRS 449.535 to 449.690, inclusive, shall take allreasonable steps as promptly as practicable to transfer care of the declarantto another physician or provider of health care.

(Added to NRS by 1991, 632)

NRS 449.630 Immunityfrom civil and criminal liability and discipline for unprofessional conduct.

1. A physician or other provider of health care is notsubject to civil or criminal liability, or discipline for unprofessionalconduct, for giving effect to a declaration or the direction of a persondesignated pursuant to NRS 449.600 inthe absence of knowledge of the revocation of a declaration, or for givingeffect to a written consent under NRS449.626.

2. A physician or other provider of health care, whoseaction pursuant to NRS 449.535 to 449.690, inclusive, is in accord withreasonable medical standards, is not subject to civil or criminal liability, ordiscipline for unprofessional conduct, with respect to that action.

3. A physician or other provider of health care, whosedecision about the validity of consent under NRS449.626 is made in good faith, is not subject to civil or criminalliability, or discipline for unprofessional conduct, with respect to that decision.

4. A person designated pursuant to NRS 449.600 or a person authorized to consentpursuant to NRS 449.626, whose decisionis made or consent is given in good faith pursuant to NRS 449.535 to 449.690, inclusive, is not subject to civilor criminal liability, or discipline for unprofessional conduct, with respectto that decision.

(Added to NRS by 1977, 760; A 1985, 1747; 1991, 635)

NRS 449.640 Considerationof declaration and other factors; failure to follow directions of patient.

1. If a patient in a terminal condition has adeclaration in effect and becomes comatose or is otherwise rendered incapableof communicating with his attending physician, the physician must give weightto the declaration as evidence of the patients directions regarding theapplication of life-sustaining treatments, but the attending physician may alsoconsider other factors in determining whether the circumstances warrantfollowing the directions.

2. No hospital or other medical facility, physician orperson working under the direction of a physician is subject to criminal or civilliability for failure to follow the directions of the patient to withhold orwithdraw life-sustaining treatments.

(Added to NRS by 1977, 761; A 1985, 1747; 1993, 2792)

NRS 449.645 Assumptionof validity of declaration; presumption of intent to use, withhold or withdrawlife-sustaining treatment not created.

1. Unless he has knowledge to the contrary, aphysician or other provider of health care may assume that a declarationcomplies with NRS 449.535 to 449.690, inclusive, and is valid.

2. NRS 449.535to 449.690, inclusive, create nopresumption concerning the intention of a person who has revoked or has notexecuted a declaration with respect to the use, withholding or withdrawal oflife-sustaining treatment in the event of a terminal condition.

(Added to NRS by 1991, 632)

NRS 449.650 Deathdoes not constitute suicide or homicide; effect of declaration on policy ofinsurance; prohibiting or requiring execution of declaration prohibited ascondition for insurance or receipt of health care.

1. Death resulting from the withholding or withdrawalof 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 itaffect, impair or modify the terms of an existing policy of life insurance orannuity. A policy of life insurance or annuity is not legally impaired orinvalidated by the withholding or withdrawal of life-sustaining treatment froman insured, notwithstanding any term to the contrary.

3. A person may not prohibit or require the executionof a declaration as a condition for being insured for, or receiving, healthcare.

(Added to NRS by 1977, 761; A 1991, 636)

NRS 449.660 Penalties.

1. A physician or other provider of health care whowillfully 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 adetermination of terminal condition or the terms of a declaration in accordancewith NRS 449.622 is guilty of a misdemeanor.

3. A person who willfully conceals, cancels, defacesor obliterates the declaration of another without the declarants consent orwho falsifies or forges a revocation of the declaration of another is guilty ofa misdemeanor.

4. A person who falsifies or forges the declaration ofanother, or willfully conceals or withholds personal knowledge of a revocation,with the intent to cause a withholding or withdrawal of life-sustainingtreatment contrary to the wishes of the declarant and thereby directly causeslife-sustaining treatment to be withheld or withdrawn and death to be hastenedis guilty of murder.

5. A person who requires or prohibits the execution ofa declaration as a condition of being insured for, or receiving, health care isguilty of a misdemeanor.

6. A person who coerces or fraudulently inducesanother to execute a declaration, or who falsifies or forges the declaration ofanother except as provided in subsection 4, is guilty of a gross misdemeanor.

7. The penalties provided in this section do notdisplace any sanction applicable under other law.

(Added to NRS by 1977, 761; A 1991, 636)

NRS 449.670 Actionscontrary to reasonable medical standards not required; mercy-killing, assistedsuicide or euthanasia not authorized.

1. NRS 449.535to 449.690, inclusive, do not require aphysician or other provider of health care to take action contrary toreasonable medical standards.

2. NRS 449.535to 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 449.680 Otherright or responsibility regarding use of life-sustaining treatment orwithholding or withdrawal of medical care not limited.NRS 449.535 to 449.690, inclusive, do not affect the rightof a patient to make decisions regarding use of life-sustaining treatment, solong as he is able to do so, or impair or supersede a right or responsibilitythat any person has to effect the withholding or withdrawal of medical care.

(Added to NRS by 1977, 761; A 1991, 637)

NRS 449.690 Validityof declaration executed in another state; effect of previously executedinstrument.

1. A declaration executed in another state incompliance with the law of that state or of this State is valid for purposes ofNRS 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 thewithholding or withdrawal of life-sustaining treatment from him when he is in aterminal condition and becomes comatose or is otherwise rendered incapable ofcommunicating with his attending physician, if executed in a manner whichattests voluntary execution, or executed anywhere before October 1, 1991, whichsubstantially 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 theDistrict of Columbia, the Commonwealth of Puerto Rico, and a territory orinsular possession subject to the jurisdiction of the United States.

(Added to NRS by 1977, 761; A 1991, 637)

PATIENTS RIGHTS

NRS 449.700 Facilityor home to provide necessary services or arrange for transfer of patient;explanation of need for transfer and alternatives available.

1. Every medical facility, facility for the dependentand home for individual residential care must provide the services necessary totreat properly a patient in a particular case or must be able to arrange thetransfer of the patient to another facility or home which can provide thatcare.

2. A patient may be transferred to another facility orhome only if the patient has received an explanation of the need to transferhim and the alternatives available, unless his condition necessitates animmediate transfer to a facility for a higher level of care and he is unable tounderstand the explanation.

(Added to NRS by 1983, 820; A 1985, 1747; 1999, 1051)

NRS 449.705 Facilityor home to forward medical records upon certain transfers of patient.

1. If a patient in a medical facility or facility forthe dependent is transferred to another medical facility or facility for thedependent, a division facility or a physician licensed to practice medicine,the facility shall forward a copy of the medical records of the patient, on orbefore the date the patient is transferred, to the other medical facility orfacility for the dependent, the division facility or the physician. Thefacility is not required to obtain the oral or written consent of the patientto forward a copy of the medical records.

2. If a person receiving services in a home forindividual residential care is transferred to another home, the home shallforward a copy of his medical records to the other home in the manner providedin subsection 1.

3. As used in this section:

(a) Division facility means any unit or subunitoperated by a division of the Department of Health and Human Services pursuantto title 39 of NRS.

(b) Medical records includes a medical history of thepatient, a summary of the current physical condition of the patient and adischarge summary which contains the information necessary for the propertreatment of the patient.

(Added to NRS by 1991, 2349; A 1993, 2725; 1999, 1051)

NRS 449.710 Specific rights: Informationconcerning facility; treatment; billing; visitation. Everypatient of a medical facility, facility for the dependent or home forindividual residential care has the right to:

1. Receiveinformation concerning any other medical or educational facility or facilityfor the dependent associated with the facility at which he is a patient whichrelates to his care.

2. Obtaininformation concerning the professional qualifications or associations of thepersons who are treating him.

3. Receive thename of the person responsible for coordinating his care in the facility orhome.

4. Be advisedif the facility in which he is a patient proposes to perform experiments onpatients which affect his own care or treatment.

5. Receivefrom his physician a complete and current description of his diagnosis, planfor treatment and prognosis in terms which he is able to understand. If it isnot medically advisable to give this information to the patient, the physicianshall:

(a) Provide theinformation to an appropriate person responsible for the patient; and

(b) Inform thatperson that he shall not disclose the information to the patient.

6. Receive fromhis physician the information necessary for him to give his informed consent toa procedure or treatment. Except in an emergency, this information must not belimited to a specific procedure or treatment and must include:

(a) Adescription of the significant medical risks involved;

(b) Anyinformation on alternatives to the treatment or procedure if he requests thatinformation;

(c) The name ofthe person responsible for the procedure or treatment; and

(d) The costslikely to be incurred for the treatment or procedure and any alternativetreatment or procedure.

7. Examine thebill for his care and receive an explanation of the bill, whether or not he ispersonally responsible for payment of the bill.

8. Know the regulations of the facility or home concerninghis conduct at the facility or home.

9. Receive, within reasonable restrictions as to timeand place, visitors of his choosing, including, without limitation, friends andmembers of his family.

(Added to NRS by 1983, 820; A 1985, 906, 1748; 1999, 1052; 2001, 3047)

NRS 449.715 Specificrights: Designation of persons authorized to visit patient in facility.

1. If, as a result of the incapacitation of thepatient or his inability to communicate, a patient of a medical facility,facility for the dependent or home for individual residential care who is 18years of age or older is unable to inform the staff of the facility or home ofthe persons whom the patient authorizes to visit the patient at the facility orhome, the facility or home shall allow visitation rights to any person designatedby the patient in a letter, form or other document authorizing visitation executedin accordance with subsection 2. The visitation rights required by thissubsection must be:

(a) Provided in accordance with the visitation policiesof the facility or home; and

(b) The same visitation rights that are provided to amember of the patients family who is legally related to the patient.

2. A person 18 years of age or older wishing todesignate a person for the purposes of establishing visitation rights in amedical facility, facility for the dependent or home for individual residentialcare may execute a letter, form or other document authorizing visitation insubstantially the following form:

 

(Date)..................................

I, ..............................., (patient who isdesignating another person as having visitation rights of the patient) dohereby designate .................................. (person who is beingdesignated as having visitation rights of the patient) as having the right tovisit me in a medical facility, facility for the dependent or home forindividual residential care. I hereby instruct all staff of a medical facility,facility for the dependent or home for individual residential care in which Iam a patient to admit ...................................... (person who isbeing designated as having visitation rights of the patient) to my room andafford him or her the same visitation rights as are provided to members of myfamily who are legally related to me during my time as a patient.

........................................................

(Signed)

 

(Added to NRS by 2003, 1879)

NRS 449.720 Specific rights: Care; refusal oftreatment and experimentation; privacy; notice of appointments and need forcare. Every patient of a medical facility,facility for the dependent or home for individual residential care has theright to:

1. Receiveconsiderate and respectful care.

2. Refusetreatment to the extent permitted by law and to be informed of the consequencesof that refusal.

3. Refuse toparticipate in any medical experiments conducted at the facility.

4. Retain hisprivacy concerning his program of medical care. Discussions of a patientscare, consultation with other persons concerning the patient, examinations ortreatments, and all communications and records concerning the patient, exceptas otherwise provided in NRS 108.640, 442.300 to 442.330, inclusive, and 449.705, and chapter629 of NRS, are confidential. The patient must consent to the presence ofany person who is not directly involved with his care during any examination,consultation or treatment.

5. Have anyreasonable request for services reasonably satisfied by the facility or homeconsidering its ability to do so.

6. Receivecontinuous care from the facility or home. The patient must be informed:

(a) Of hisappointments for treatment and the names of the persons available at thefacility or home for those treatments; and

(b) By his physician or an authorized representative ofthe physician, of his need for continuing care.

(Added to NRS by 1983, 821; A 1985, 1748; 1989, 2057;1991, 2350; 1999,1052, 3512)

NRS 449.730 Patientto be informed of rights upon admission to facility or home for individualcare; required disclosures and notices.

1. Every medical facility, facility for the dependentand home for individual residential care shall inform each patient or his legalrepresentative, upon his admission to the facility or home, of the patientsrights as listed in NRS 449.700, 449.710, 449.715and 449.720.

2. In addition to the requirements of subsection 1, ifa person with a disability is a patient at a facility, as that term is definedin NRS 449.771, the facility shallinform the patient of his rights pursuant to NRS449.765 to 449.786, inclusive.

3. In addition to the requirements of subsections 1and 2, every hospital shall, upon the admission of a patient to the hospital,provide to the patient or his legal representative a written disclosureapproved by the Director, which written disclosure must set forth:

(a) Notice of the existence of the Bureau for HospitalPatients created pursuant to NRS 223.575;

(b) The address and telephone number of the Bureau; and

(c) An explanation of the services provided by theBureau, including, without limitation, the services for dispute resolutiondescribed in subsection 3 of NRS 223.575.

4. In addition to the requirements of subsections 1, 2and 3, every hospital shall, upon the discharge of a patient from the hospital,provide to the patient or his legal representative a written disclosureapproved by the Director, which written disclosure must set forth:

(a) If the hospital is a major hospital:

(1) Notice of the reduction or discountavailable pursuant to NRS 439B.260,including, without limitation, notice of the criteria a patient must satisfy toqualify for a reduction or discount under that section; and

(2) Notice of any policies and procedures thehospital may have adopted to reduce charges for services provided to persons orto provide discounted services to persons, which policies and procedures are inaddition to any reduction or discount required to be provided pursuant to NRS 439B.260. The notice required by thissubparagraph must describe the criteria a patient must satisfy to qualify forthe additional reduction or discount, including, without limitation, anyrelevant limitations on income and any relevant requirements as to the periodwithin which the patient must arrange to make payment.

(b) If the hospital is not a major hospital, notice ofany policies and procedures the hospital may have adopted to reduce charges forservices provided to persons or to provide discounted services to persons. Thenotice required by this paragraph must describe the criteria a patient mustsatisfy to qualify for the reduction or discount, including, withoutlimitation, any relevant limitations on income and any relevant requirements asto the period within which the patient must arrange to make payment.

As used inthis subsection, major hospital has the meaning ascribed to it in NRS 439B.115.

5. In addition to the requirements of subsections 1 to4, inclusive, every hospital shall post in a conspicuous place in each publicwaiting room in the hospital a legible sign or notice in 14-point type orlarger, which sign or notice must:

(a) Provide a brief description of any policies andprocedures the hospital may have adopted to reduce charges for servicesprovided to persons or to provide discounted services to persons, including,without limitation:

(1) Instructions for receiving additionalinformation 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)

NRS 449.740 Procedureto insert implant in breast of patient: Informed consent required; withdrawalof consent; penalty.

1. A physician shall not perform any procedure toinsert an implant in the breast of a patient unless within 5 days before theprocedure is performed he has:

(a) Discussed with the patient and any other personwhose consent is required pursuant to paragraph (b), the advantages,disadvantages and risks associated with the procedure; and

(b) Obtained informed consent in writing from thefollowing persons freely and without coercion:

(1) The patient if he is 18 years of age or overor legally emancipated and competent to give that consent, and from his legalguardian, if any;

(2) The parent or guardian of a patient under 18years of age and not legally emancipated; or

(3) The legal guardian of a patient of any agewho has been adjudicated mentally incompetent,

and therequired consent was not withdrawn pursuant to subsection 3 before theprocedure began.

2. An informed consent requires that the person whoseconsent 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 consentis required pursuant to paragraph (b) of subsection 1 may be withdrawn inwriting 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 thepatient 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 theHealth Division pursuant to NRS 449.750in a language that the person is able to read.

(b) Paragraph (b) of subsection 1 if the person orpersons whose consent is required sign a copy of the current consent formprepared by the Health Division pursuant to NRS449.750 freely and without coercion and the consent is not withdrawnpursuant to subsection 3 before the procedure has begun. The consent form mustbe in a language that the person who signs the form is able to read.

5. Any person who violates the provisions of thissection is guilty of a misdemeanor.

(Added to NRS by 1991, 1690)

NRS 449.750 Procedureto insert implant in breast of patient: Contents of explanation form andconsent form; fee for forms.

1. The Health Division shall prepare and provide tophysicians upon request:

(a) An explanation form for a procedure to insert animplant 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 thebreast of a person, including any known side effects; and

(2) Any other information the Health Divisiondetermines to be useful to a person contemplating a procedure to insert animplant in the breast; and

(b) A consent form for a procedure to insert an implantin the breast of a person which includes:

(1) The nature and consequences of theprocedure;

(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 explanationform and consent form as necessary to keep the medical information current.

3. The Health Division shall charge and collect a feefor all forms distributed pursuant to this section that is adequate to coverthe cost of producing the forms.

(Added to NRS by 1991, 1690)

PREVENTING PERSONS FROM ENTERING OR EXITING HEALTH FACILITY

NRS 449.760 Unlawfulto prevent person from entering or exiting office of physician or healthfacility or center; exceptions; penalty.

1. Except as otherwise provided in this section, aperson shall not intentionally prevent another person from entering or exitingthe office of a physician, a health facility, a nonprofit health facility, apublic health center, a medical facility or a facility for the dependent byphysically:

(a) Detaining the other person; or

(b) Obstructing, impeding or hindering the otherpersons 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, medicalfacility or facility for the dependent; or

(b) A peace officer as defined in NRS 169.125,

while actingwithin the course and scope of his duties or employment.

3. The provisions of subsection 1 do not prohibit aperson from maintaining a picket during a strike or work stoppage in compliancewith the provisions of NRS 614.160, orfrom engaging in any constitutionally protected exercise of free speech.

4. A person who violates the provisions of subsection1 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 byboth fine and imprisonment.

5. As used in this section, the terms healthfacility, nonprofit health facility and public health center have themeanings ascribed to them in NRS 449.260.

(Added to NRS by 1991, 1687)

USE OF AVERSIVE INTERVENTION OR FORMS OF RESTRAINT ONPATIENTS WITH DISABILITIES

NRS 449.765 Definitions. As used in NRS 449.765to 449.786, inclusive, unless thecontext otherwise requires, the words and terms defined in NRS 449.766 to 449.775, inclusive, have the meaningsascribed to them in those sections.

(Added to NRS by 1999, 3247)

NRS 449.766 Aversiveintervention defined. Aversive interventionmeans any of the following actions if the action is used to punish a personwith a disability or to eliminate, reduce or discourage maladaptive behavior ofa 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 forcedconditions if the:

(a) Person is required to perform the exercise becausehe exhibited a behavior that is related to his disability;

(b) Exercise is harmful to the health of the personbecause of his disability; or

(c) Nature of the persons disability prevents him fromengaging in the exercise;

8. Any intervention, technique or procedure thatdeprives a person of the use of one or more of his senses, regardless of the lengthof the deprivation, including, without limitation, the use of sensory screens;or

9. The deprivation of necessities needed to sustainthe 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 customarilyserved; or

(b) Medication.

The termdoes not include the withholding or withdrawal of life-sustaining treatment inaccordance with NRS 449.626.

(Added to NRS by 1999, 3247)

NRS 449.767 Chemicalrestraint defined. Chemical restraint meansthe administration of drugs for the specific and exclusive purpose ofcontrolling an acute or episodic aggressive behavior when alternativeintervention techniques have failed to limit or control the behavior. The termdoes not include the administration of drugs on a regular basis, as prescribedby a physician, to treat the symptoms of mental, physical, emotional orbehavioral disorders and for assisting a person in gaining self-control overhis impulses.

(Added to NRS by 1999, 3247)

NRS 449.768 Corporalpunishment defined. Corporal punishmentmeans the intentional infliction of physical pain, including, withoutlimitation, hitting, pinching or striking.

(Added to NRS by 1999, 3248)

NRS 449.769 Electricshock defined. Electric shock means theapplication of electric current to a persons skin or body. The term does notinclude electroconvulsive therapy.

(Added to NRS by 1999, 3248)

NRS 449.770 Emergencydefined. Emergency means a situation inwhich immediate intervention is necessary to protect the physical safety of aperson or others from an immediate threat of physical injury or to protectagainst an immediate threat of severe property damage.

(Added to NRS by 1999, 3248)

NRS 449.771 Facilitydefined. Facility means a facility licensedpursuant to this chapter that is a psychiatric hospital or a unit of a hospitalthat is specifically designated to provide care and services to persons withpsychiatric or developmental disabilities.

(Added to NRS by 1999, 3248)

NRS 449.772 Mechanicalrestraint defined. Mechanical restraintmeans the use of devices, including, without limitation, mittens, straps andrestraint chairs to limit a persons movement or hold a person immobile.

(Added to NRS by 1999, 3248)

NRS 449.773 Personwith a disability defined. Person with adisability means a person who:

1. Has a physical or mental impairment thatsubstantially 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)

NRS 449.774 Physicalrestraint defined. Physical restraint meansthe use of physical contact to limit a persons movement or hold a person immobile.

(Added to NRS by 1999, 3248)

NRS 449.775 Verbaland mental abuse defined. Verbal and mentalabuse means actions or utterances that are intended to cause and actuallycause severe emotional distress to a person.

(Added to NRS by 1999, 3248)

NRS 449.776 Aversiveintervention: Prohibition on use. A person employedby a facility licensed pursuant to this chapter or any other person shall notuse any aversive intervention on a person with a disability who is a patient atthe facility.

(Added to NRS by 1999, 3248)

NRS 449.777 Formsof restraint: Restrictions on use. A personemployed by a facility licensed pursuant to this chapter or any other personshall not:

1. Except as otherwise provided in NRS 449.778, use physical restraint on aperson with a disability who is a patient at the facility.

2. Except as otherwise provided in NRS 449.779, use mechanical restraint on aperson with a disability who is a patient at the facility.

3. Except as otherwise provided in NRS 449.780, use chemical restraint on aperson with a disability who is a patient at the facility.

(Added to NRS by 1999, 3248)

NRS 449.778 Physical restraint: Permissibleuse; report of use in emergency.

1. Except as otherwise provided in subsection 2, physicalrestraint may be used on a person with a disability who is a patient at afacility only if:

(a) An emergency exists that necessitates the use ofphysical restraint;

(b) The physical restraint is used only for the periodthat is necessary to contain the behavior of the patient so that the patient isno longer an immediate threat of causing physical injury to himself or othersor causing severe property damage; and

(c) The use of force in the application of physicalrestraint does not exceed the force that is reasonable and necessary under thecircumstances precipitating the use of physical restraint.

2. Physical restraint may be used on a person with adisability who is a patient at a facility and the provisions of subsection 1 donot apply if the physical restraint is used to:

(a) Assist the patient in completing a task or responseif the patient does not resist the application of physical restraint or if hisresistance is minimal in intensity and duration;

(b) Escort or carry a patient to safety if the patientis in danger in his present location; or

(c) Conduct medical examinations or treatments on thepatient that are necessary.

3. If physical restraint is used on a person with adisability who is a patient at a facility in an emergency, the use of theprocedure must be reported as a denial of rights pursuant to NRS 449.786, regardless of whether the useof the procedure is authorized by statute. The report must be made not laterthan 1 working day after the procedure is used.

(Added to NRS by 1999, 3249)

NRS 449.779 Mechanicalrestraint: Permissible use; report of use in emergency.

1. Except as otherwise provided in subsection 2,mechanical restraint may be used on a person with a disability who is a patientat a facility only if:

(a) An emergency exists that necessitates the use ofmechanical restraint;

(b) A medical order authorizing the use of mechanicalrestraint is obtained from the patients treating physician before theapplication of the mechanical restraint or not later than 15 minutes after theapplication of the mechanical restraint;

(c) The physician who signed the order required pursuantto paragraph (b) or the attending physician examines the patient not later than1 working day immediately after the application of the mechanical restraint;

(d) The mechanical restraint is applied by a member ofthe staff of the facility who is trained and qualified to apply mechanicalrestraint;

(e) The patient is given the opportunity to move andexercise the parts of his body that are restrained at least 10 minutes perevery 60 minutes of restraint;

(f) A member of the staff of the facility lessens ordiscontinues the restraint every 15 minutes to determine whether the patientwill stop or control his inappropriate behavior without the use of therestraint;

(g) The record of the patient contains a notation thatincludes the time of day that the restraint was lessened or discontinuedpursuant to paragraph (f), the response of the patient and the response of themember of the staff of the facility who applied the mechanical restraint;

(h) A member of the staff of the facility continuouslymonitors the patient during the time that mechanical restraint is used on thepatient; and

(i) The patient is released from the mechanicalrestraint as soon as his behavior no longer presents an immediate threat tohimself or others.

2. Mechanical restraint may be used on a person with adisability who is a patient at a facility and the provisions of subsection 1 donot 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 ofinjury to himself because he lacks coordination or suffers from frequent lossof consciousness;

(c) Provide proper body alignment to a patient; or

(d) Position a patient who has physical disabilities ina manner prescribed in the patients plan of treatment.

3. If mechanical restraint is used on a person with adisability who is a patient at a facility in an emergency, the use of theprocedure must be reported as a denial of rights pursuant to NRS 449.786, regardless of whether the useof the procedure is authorized by statute. The report must be made not laterthan 1 working day after the procedure is used.

(Added to NRS by 1999, 3249)

NRS 449.780 Chemicalrestraint: Permissible use; report of use.

1. Chemical restraint may only be used on a personwith a disability who is a patient at a facility if:

(a) The patient has been diagnosed as mentally ill, asdefined in NRS 433A.115, and isreceiving mental health services from a facility;

(b) The chemical restraint is administered to thepatient while he is under the care of the facility;

(c) An emergency exists that necessitates the use ofchemical restraint;

(d) A medical order authorizing the use of chemicalrestraint is obtained from the patients attending physician or psychiatrist;

(e) The physician or psychiatrist who signed the orderrequired pursuant to paragraph (d) examines the patient not later than 1working day immediately after the administration of the chemical restraint; and

(f) The chemical restraint is administered by a personlicensed to administer medication.

2. If chemical restraint is used on a person with adisability who is a patient, the use of the procedure must be reported as adenial of rights pursuant to NRS 449.786,regardless of whether the use of the procedure is authorized by statute. Thereport must be made not later than 1 working day after the procedure is used.

(Added to NRS by 1999, 3250)

NRS 449.781 Useof forms of restraint by certain facilities. Notwithstandingthe provisions of NRS 449.777 to 449.780, inclusive, to the contrary, afacility may use or authorize the use of physical restraint, mechanicalrestraint or chemical restraint on a person with a disability who is a patientif the facility is:

1. Accredited by a nationally recognized accreditationassociation or agency; or

2. Certified for participation in the Medicaid orMedicare program,

only to theextent that the accreditation or certification allows the use of such restraint.

(Added to NRS by 1999, 3248)

NRS 449.782 Educationand training of members of staff of facility.

1. Each facility shall develop a program of educationfor the members of the staff of the facility to provide instruction in positivebehavioral interventions and positive behavioral supports that:

(a) Includes positive methods to modify the environmentof patients to promote adaptive behavior and reduce the occurrence ofinappropriate behavior;

(b) Includes methods to teach skills to patients sothat patients can replace inappropriate behavior with adaptive behavior;

(c) Includes methods to enhance a patientsindependence and quality of life;

(d) Includes the use of the least intrusive methods torespond to and reinforce the behavior of patients; and

(e) Offers a process for designing interventions basedupon the patient that are focused on promoting appropriate changes in behavioras well as enhancing the overall quality of life for the patient.

2. Each facility shall provide appropriate trainingfor the members of the staff of the facility who are authorized to carry outand monitor physical restraint and mechanical restraint to ensure that thosemembers of the staff are competent and qualified to carry out the procedures inaccordance with NRS 449.765 to 449.786, inclusive.

(Added to NRS by 1999, 3250)

NRS 449.783 Violations:Criminal penalties; ineligibility for employment; disciplinary action.

1. Unless a more severe penalty is prescribed byspecific statute, a person who willfully uses aversive intervention on a personwith a disability who is a patient at a facility or, except as otherwiseprovided in NRS 449.781, violates NRS 449.777:

(a) For a first violation that does not result insubstantial bodily harm to the person with a disability, is guilty of a grossmisdemeanor.

(b) For a first violation that results in substantialbodily harm to the person with a disability, is guilty of a category B felony.

(c) For a second or subsequent violation, is guilty ofa category B felony.

A person whois convicted of a category B felony pursuant to this section shall be punishedby imprisonment in the state prison for a minimum term of not less than 1 yearand 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 sectionis ineligible for 5 years for employment with a facility.

3. A conviction pursuant to this section is, whenapplicable, grounds for disciplinary action against the person so convicted andthe facility where the violation occurred. The Health Division may recommend tothe appropriate agency or board the suspension or revocation of theprofessional license, registration, certificate or permit of a personconvicted.

(Added to NRS by 1999, 3251)

NRS 449.784 Violations:Report required; development and review of and compliance with corrective plan.

1. A facility where a violation of the provisions of NRS 449.765 to 449.786, inclusive, occurs shall report theviolation to the Health Division not later than 24 hours after the violationoccurred, or as soon thereafter as the violation is discovered.

2. A facility where a violation occurred shalldevelop, in cooperation with the Health Division, a corrective plan to ensurethat within 30 calendar days after the violation occurred, appropriate actionis taken by the facility to prevent future violations.

3. The Health Division shall forward the plan to theBoard. The Board shall review the plan to ensure that it complies withapplicable federal law and the statutes and regulations of this state. TheBoard may require appropriate revision of the plan to ensure compliance.

4. If the facility where the violation occurred doesnot meet the requirements of the plan to the satisfaction of the Board, theBoard may direct the agency that administers funding for the facility towithhold state funding for the facility until the facility meets therequirements of the plan.

(Added to NRS by 1999, 3251)

NRS 449.785 Prohibitionon retaliation against person for reporting or providing information regardingviolation. An officer, administrator or employeeof a facility licensed pursuant to this chapter shall not retaliate against anyperson 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,

by afacility or a member of the staff of the facility.

(Added to NRS by 1999, 3252)

NRS 449.786 Entryof denial of rights in patients record; notice and report of denial; action byHealth Division.

1. A denial of rights of a person with a disabilitywho is a patient of a facility pursuant to NRS449.765 to 449.786, inclusive, mustbe entered in the patients record. Notice of the denial must be provided tothe administrator of the facility.

2. If the administrator of a facility receives noticeof a denial of rights pursuant to subsection 1, he shall cause a full report tobe prepared which must set forth in detail the factual circumstancessurrounding the denial. A copy of the report must be provided to the HealthDivision.

3. The Health Division:

(a) Shall receive reports made pursuant to subsection2;

(b) May investigate apparent violations of the rightsof persons with disabilities who are patients at facilities; and

(c) May act to resolve disputes relating to apparentviolations.

(Added to NRS by 1999, 3252)

DURABLE POWER OF ATTORNEY FOR HEALTH CARE

NRS 449.800 Definitions. As used in NRS 449.800to 449.860, inclusive, unless thecontext 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 adisabled principal.

3. Principal means a natural person who has executeda power of attorney for a disabled principal.

4. Provider of health care has the meaning ascribedto it in NRS 629.031.

(Added to NRS by 1987, 913)

NRS 449.810 Executionof power of attorney to make decisions concerning health care; conditions. Any adult person may execute a power of attorney for adisabled principal enabling the attorney-in-fact named in the power of attorneyto make decisions concerning health care for the principal who executed thepower of attorney if that principal becomes incapable of giving informedconsent concerning such decisions.

(Added to NRS by 1987, 914)

NRS 449.820 Personsnot eligible for designation as attorney-in-fact.

1. Except as otherwise provided in subsection 2, aprincipal 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 personidentified in subsection 1 if that person is the spouse, legal guardian or nextof kin of the principal.

(Added to NRS by 1987, 914; A 1991, 1563)

NRS 449.830 Powerof attorney: Form. The form of a power ofattorney for a disabled principal must be substantially as follows:

 

DURABLE POWER OFATTORNEY

FOR HEALTH CAREDECISIONS

 

WARNING TO PERSONEXECUTING THIS DOCUMENT

 

THIS IS AN IMPORTANT LEGAL DOCUMENT. IT CREATES ADURABLE POWER OF ATTORNEY FOR HEALTH CARE. BEFORE EXECUTING THIS DOCUMENT, YOUSHOULD KNOW THESE IMPORTANT FACTS:

1. THIS DOCUMENT GIVES THE PERSON YOU DESIGNATE ASYOUR ATTORNEY-IN-FACT THE POWER TO MAKE HEALTH CARE DECISIONS FOR YOU. THISPOWER IS SUBJECT TO ANY LIMITATIONS OR STATEMENT OF YOUR DESIRES THAT YOUINCLUDE IN THIS DOCUMENT. THE POWER TO MAKE HEALTH CARE DECISIONS FOR YOU MAYINCLUDE CONSENT, REFUSAL OF CONSENT, OR WITHDRAWAL OF CONSENT TO ANY CARE,TREATMENT, SERVICE, OR PROCEDURE TO MAINTAIN, DIAGNOSE, OR TREAT A PHYSICAL ORMENTAL CONDITION. YOU MAY STATE IN THIS DOCUMENT ANY TYPES OF TREATMENT OR PLACEMENTSTHAT YOU DO NOT DESIRE.

2. THE PERSON YOU DESIGNATE IN THIS DOCUMENT HAS ADUTY TO ACT CONSISTENT WITH YOUR DESIRES AS STATED IN THIS DOCUMENT OROTHERWISE MADE KNOWN OR, IF YOUR DESIRES ARE UNKNOWN, TO ACT IN YOUR BESTINTERESTS.

3. EXCEPT AS YOU OTHERWISE SPECIFY IN THIS DOCUMENT,THE POWER OF THE PERSON YOU DESIGNATE TO MAKE HEALTH CARE DECISIONS FOR YOU MAYINCLUDE THE POWER TO CONSENT TO YOUR DOCTOR NOT GIVING TREATMENT OR STOPPINGTREATMENT WHICH WOULD KEEP YOU ALIVE.

4. UNLESS YOU SPECIFY A SHORTER PERIOD IN THISDOCUMENT, THIS POWER WILL EXIST INDEFINITELY FROM THE DATE YOU EXECUTE THISDOCUMENT 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 MAKEHEALTH CARE DECISIONS FOR YOURSELF.

5. NOTWITHSTANDING THIS DOCUMENT, YOU HAVE THE RIGHTTO MAKE MEDICAL AND OTHER HEALTH CARE DECISIONS FOR YOURSELF SO LONG AS YOU CANGIVE INFORMED CONSENT WITH RESPECT TO THE PARTICULAR DECISION. IN ADDITION, NOTREATMENT MAY BE GIVEN TO YOU OVER YOUR OBJECTION, AND HEALTH CARE NECESSARY TOKEEP YOU ALIVE MAY NOT BE STOPPED IF YOU OBJECT.

6. YOU HAVE THE RIGHT TO REVOKE THE APPOINTMENT OF THEPERSON DESIGNATED IN THIS DOCUMENT TO MAKE HEALTH CARE DECISIONS FOR YOU BYNOTIFYING THAT PERSON OF THE REVOCATION ORALLY OR IN WRITING.

7. YOU HAVE THE RIGHT TO REVOKE THE AUTHORITY GRANTEDTO THE PERSON DESIGNATED IN THIS DOCUMENT TO MAKE HEALTH CARE DECISIONS FOR YOUBY NOTIFYING THE TREATING PHYSICIAN, HOSPITAL, OR OTHER PROVIDER OF HEALTH CAREORALLY OR IN WRITING.

8. THE PERSON DESIGNATED IN THIS DOCUMENT TO MAKEHEALTH CARE DECISIONS FOR YOU HAS THE RIGHT TO EXAMINE YOUR MEDICAL RECORDS ANDTO CONSENT TO THEIR DISCLOSURE UNLESS YOU LIMIT THIS RIGHT IN THIS DOCUMENT.

9. THIS DOCUMENT REVOKES ANY PRIOR DURABLE POWER OFATTORNEY FOR HEALTH CARE.

10. IF THERE IS ANYTHING IN THIS DOCUMENT THAT YOU DONOT 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 meas authorized in this document.

(Insert the name and address of the person you wish todesignate as your attorney-in-fact to make health care decisions for you.Unless the person is also your spouse, legal guardian or the person mostclosely related to you by blood, none of the following may be designated asyour attorney-in-fact: (1) your treating provider of health care, (2) anemployee of your treating provider of health care, (3) an operator of a healthcare facility, or (4) an employee of an operator of a health care facility.)

2. CREATION OF DURABLE POWER OF ATTORNEY FOR HEALTHCARE.

By this document I intend to create a durable power ofattorney by appointing the person designated above to make health caredecisions for me. This power of attorney shall not be affected by my subsequentincapacity.

3. GENERAL STATEMENT OF AUTHORITY GRANTED.

In the event that I am incapable of giving informedconsent with respect to health care decisions, I hereby grant to theattorney-in-fact named above full power and authority to make health caredecisions for me before, or after my death, including: consent, refusal ofconsent, or withdrawal of consent to any care, treatment, service, or procedureto maintain, diagnose, or treat a physical or mental condition, subject only tothe 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 toany of the following: commitment to or placement in a mental health treatmentfacility, convulsive treatment, psychosurgery, sterilization, or abortion. Ifthere are any other types of treatment or placement that you do not want yourattorney-in-facts authority to give consent for or other restrictions you wishto place on his or her attorney-in-facts authority, you should list them inthe space below. If you do not write any limitations, your attorney-in-factwill have the broad powers to make health care decisions on your behalf whichare set forth in paragraph 3, except to the extent that there are limitsprovided by law.)

In exercising the authority under this durable power ofattorney for health care, the authority of my attorney-in-fact is subject tothe following special provisions and limitations:

.......................................................................................................................................................

.......................................................................................................................................................

.......................................................................................................................................................

.......................................................................................................................................................

5. DURATION.

I understand that this power of attorney will existindefinitely from the date I execute this document unless I establish a shortertime. If I am unable to make health care decisions for myself when this powerof attorney expires, the authority I have granted my attorney-in-fact willcontinue to exist until the time when I become able to make health caredecisions for myself.

 

(IF APPLICABLE)

I wish to have this power of attorneyend on the following date:......

6. STATEMENT OF DESIRES.

(With respect to decisions to withhold or withdrawlife-sustaining treatment, your attorney-in-fact must make health caredecisions that are consistent with your known desires. You can, but are notrequired to, indicate your desires below. If your desires are unknown, yourattorney-in-fact has the duty to act in your best interests; and, under somecircumstances, a judicial proceeding may be necessary so that a court candetermine the health care decision that is in your best interests. If you wishto indicate your desires, you may INITIAL the statement or statements thatreflect 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 beprolonged to the greatest extent possible, without regard to my condition, thechances I have for recovery or long-term survival, or the cost of theprocedures......... [ ]

2. If I am in a coma whichmy doctors have reasonably concluded is irreversible, I desire thatlife-sustaining or prolonging treatments not be used. (Also should utilizeprovisions of NRS 449.535 to 449.690, inclusive, if this subparagraph isinitialed.) [............................................ ]

3. If I have an incurableor terminal condition or illness and no reasonable hope of long-term recoveryor survival, I desire that life-sustaining or prolonging treatments not beused. (Also should utilize provisions of NRS449.535 to 449.690, inclusive, ifthis subparagraph is initialed.)......................................... [ ]

4. Withholding orwithdrawal of artificial nutrition and hydration may result in death bystarvation or dehydration. I want to receive or continue receiving artificialnutrition and hydration by way of the gastrointestinal tract after all othertreatment is withheld. [............................................ ]

5. I do not desiretreatment to be provided and/or continued if the burdens of the treatmentoutweigh the expected benefits. My attorney-in-fact is to consider the reliefof suffering, the preservation or restoration of functioning, and the qualityas well as the extent of the possible extension of my life. [ ]

 

(If you wish to change your answer, you may do so bydrawing an X through the answer you do not want, and circling the answer youprefer.)

Other or Additional Statements of Desires:.....................................................................

.......................................................................................................................................................

.......................................................................................................................................................

.......................................................................................................................................................

.......................................................................................................................................................

.......................................................................................................................................................

 

7. DESIGNATION OF ALTERNATE ATTORNEY-IN-FACT.

(You are not required to designate any alternativeattorney-in-fact but you may do so. Any alternative attorney-in-fact youdesignate will be able to make the same health care decisions as theattorney-in-fact designated in paragraph 1, page 2, in the event that he or sheis unable or unwilling to act as your attorney-in-fact. Also, if theattorney-in-fact designated in paragraph 1 is your spouse, his or herdesignation as your attorney-in-fact is automatically revoked by law if yourmarriage is dissolved.)

If the person designated in paragraph 1 as myattorney-in-fact is unable to make health care decisions for me, then Idesignate the following persons to serve as my attorney-in-fact to make healthcare decisions for me as authorized in this document, such persons to serve inthe 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 healthcare.

 

(YOUMUST DATE AND SIGN THIS POWER OF ATTORNEY)

 

Isign 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 MAKINGHEALTH CARE DECISIONS UNLESS IT IS EITHER (1) SIGNED BY AT LEAST TWO QUALIFIEDWITNESSES WHO ARE PERSONALLY KNOWN TO YOU AND WHO ARE PRESENT WHEN YOU SIGN ORACKNOWLEDGE YOUR SIGNATURE OR (2) ACKNOWLEDGED BEFORE A NOTARY PUBLIC.)

 

CERTIFICATE OFACKNOWLEDGMENT OF NOTARY PUBLIC

 

(You may use acknowledgment before a notary public instead ofthe statement of witnesses.)

 

State of Nevada }

}ss.

County of............................................. }

 

On this ................ day of ................, inthe year ..., before me, ................................ (here insert name ofnotary public) personally appeared ................................ (hereinsert name of principal) personally known to me (or proved to me on the basisof satisfactory evidence) to be the person whose name is subscribed to thisinstrument, and acknowledged that he or she executed it. I declare underpenalty of perjury that the person whose name is ascribed to this instrumentappears to be of sound mind and under no duress, fraud, or undue influence.

 

NOTARY SEAL

(Signatureof 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 witnessingprocedure. If you elect to use witnesses instead of having this documentnotarized you must use two qualified adult witnesses. None of the following maybe used as a witness: (1) a person you designate as the attorney-in-fact, (2) aprovider of health care, (3) an employee of a provider of health care, (4) theoperator of a health care facility, (5) an employee of an operator of a healthcare facility. At least one of the witnesses must make the additionaldeclaration set out following the place where the witnesses sign.)

I declare under penalty of perjury that the principalis personally known to me, that the principal signed or acknowledged thisdurable power of attorney in my presence, that the principal appears to be ofsound mind and under no duress, fraud, or undue influence, that I am not theperson appointed as attorney-in-fact by this document, and that I am not aprovider of health care, an employee of a provider of health care, the operatorof a community care facility, nor an employee of an operator of a health carefacility.

 

Signature:............................................................. ResidenceAddress:..............................

Print Name:...........................................................

Date:......................................................................

 

Signature:............................................................. ResidenceAddress:..............................

Print Name:...........................................................

Date:......................................................................

 

(AT LEAST ONE OF THE ABOVE WITNESSES MUST ALSO SIGN THEFOLLOWING DECLARATION.)

 

I declare under penalty of perjury that I am notrelated to the principal by blood, marriage, or adoption, and to the best of myknowledge I am not entitled to any part of the estate of the principal upon thedeath 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 documentand give one to your attorney-in-fact. The power of attorney should beavailable 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)

NRS 449.840 Powerof attorney: Acknowledgment; witnesses.

1. The principals signature on the power of attorneymust:

(a) Be acknowledged before a notary public; or

(b) Witnessed by two adult witnesses who know theprincipal personally.

2. Neither of the witnesses to a principals signaturemay 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 principalssignature must be a person who is:

(a) Not related to the principal by blood, marriage oradoption; and

(b) To the best of the witnesses knowledge, notentitled to any part of the estate of the principal upon the death of theprincipal.

(Added to NRS by 1987, 914)

NRS 449.850 Attorney-in-fact:Prohibited acts; duties.

1. The attorney-in-fact may not consent to:

(a) Commitment or placement of the principal in afacility for treatment of mental illness;

(b) Convulsive treatment;

(c) Psychosurgery;

(d) Sterilization;

(e) Abortion;

(f) Aversiveintervention, as that term is defined in NRS449.766; or

(g) Any other treatment to which the principal, in thepower of attorney, states that the attorney-in-fact may not consent.

2. The attorney-in-fact must make decisions concerningthe use or nonuse of life sustaining treatment which conform to the knowndesires of the principal. The principal may make these desires known in thepower of attorney.

(Added to NRS by 1987, 914; A 1999, 3252)

NRS 449.860 Designationof attorney-in-fact: Alternate; revocation; validity; expiration.

1. The principal may designate an alternateattorney-in-fact.

2. If a principal designates his spouse as theattorney-in-fact or as an alternate, that designation is automatically revokedif the principal and his spouse are divorced.

3. An execution of a power of attorney automaticallyrevokes any previous power of attorney.

4. A power of attorney remains valid indefinitelyunless:

(a) The principal designates a shorter period for whichit is to remain valid; or

(b) It is revoked.

5. If a power of attorney expires while the principalis unable to make decisions concerning health care, the power of attorneyremains valid until the principal is again able to make such decisions.

(Added to NRS by 1987, 914)

 

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