NRS: CHAPTER 449A - CARE AND RIGHTS OF PATIENTS

[Rev. 6/29/2024 4:09:24 PM--2023]

CHAPTER 449A - CARE AND RIGHTS OF PATIENTS

GENERAL PROVISIONS

NRS 449A.001 Definitions.

NRS 449A.007 “Board” defined.

NRS 449A.017 “Division” defined.

NRS 449A.031 “Facility for the dependent” defined.

NRS 449A.045 “Hospital” defined.

NRS 449A.050 “Medical facility” defined.

NRS 449A.064 “Provider of health care” defined.

NRS 449A.071 “Registered nurse” defined.

NRS 449A.074 “Residential facility for groups” defined.

NRS 449A.081 “Terminally ill” defined.

PATIENTS’ RIGHTS

NRS 449A.100 Facility to provide necessary services or arrange for transfer of patient; explanation of need for transfer and alternatives available.

NRS 449A.103 Facility to forward medical records upon certain transfers of patient.

NRS 449A.106 Specific rights: Information concerning facility; treatment; billing; visitation.

NRS 449A.109 Specific rights: Designation of persons authorized to visit patient in facility.

NRS 449A.112 Specific rights: Care; refusal of treatment and experimentation; privacy; notice of appointments and need for care; confidentiality of information concerning patient.

NRS 449A.114 Certain facilities to notify patient and State Long-Term Care Ombudsman of intent to transfer patient and provide opportunity for patient or representative to meet with administrator; exceptions.

NRS 449A.115 Owner and administrator of certain facility prohibited from receiving certain money or property from resident or former resident; exception.

NRS 449A.118 Patient to be informed of rights upon admission to facility; required disclosures and notices.

NRS 449A.119 Provision of information by off-campus location of hospital where emergency room services are provided.

NRS 449A.121 Procedure to insert implant in breast of patient: Informed consent required; withdrawal of consent; penalty.

NRS 449A.124 Procedure to insert implant in breast of patient: Contents of explanation form and consent form; fee for forms.

COLLECTION OF AMOUNT OWED FOR HOSPITAL CARE

NRS 449A.150 Definitions.

NRS 449A.153 “Hospital care” defined.

NRS 449A.156 “Responsible party” defined.

NRS 449A.159 Limitations on efforts of hospitals to collect; date for accrual of interest; rate of interest; limitations on additional fees.

NRS 449A.162 Limitations on efforts of hospital to collect when hospital has contractual agreement with third party that provides health coverage for care provided; return to patient of any excess amount collected; exception. [Effective through December 31, 2025.]

NRS 449A.165 Manner of collection.

INSTALLATION AND USE OF ELECTRONIC COMMUNICATION DEVICES IN FACILITIES FOR SKILLED NURSING

NRS 449A.170 Definitions.

NRS 449A.172 “Facility for skilled nursing” defined.

NRS 449A.174 “Guardian” defined.

NRS 449A.176 “Living quarters” defined.

NRS 449A.178 “Representative” defined.

NRS 449A.180 Requirements for representative of patient.

NRS 449A.182 Request for installation and use: Contents; form; approval; facility to attempt to accommodate patient if roommate refuses consent; withdrawal.

NRS 449A.184 Responsibilities of patient; requirements for device.

NRS 449A.186 Prohibitions; exceptions.

NRS 449A.188 Penalties.

NRS 449A.190 Facility to post notice where device is in use; employee prohibited from refusing to perform duties because of device.

NRS 449A.192 Regulations; inapplicability where device installed by law enforcement agency.

USE OF AVERSIVE INTERVENTION OR FORMS OF RESTRAINT ON PATIENTS WITH DISABILITIES

NRS 449A.200 Definitions.

NRS 449A.203 “Aversive intervention” defined.

NRS 449A.206 “Chemical restraint” defined.

NRS 449A.209 “Corporal punishment” defined.

NRS 449A.212 “Electric shock” defined.

NRS 449A.215 “Emergency” defined.

NRS 449A.218 “Facility” defined.

NRS 449A.221 “Mechanical restraint” defined.

NRS 449A.224 “Person with a disability” defined.

NRS 449A.227 “Physical restraint” defined.

NRS 449A.230 “Verbal and mental abuse” defined.

NRS 449A.233 Aversive intervention: Prohibition on use.

NRS 449A.236 Forms of restraint: Restrictions on use.

NRS 449A.239 Physical restraint: Permissible use; report of use in emergency.

NRS 449A.242 Mechanical restraint: Permissible use; report of use in emergency.

NRS 449A.245 Chemical restraint: Permissible use; report of use.

NRS 449A.248 Authorized use of certain forms of restraint by certain facilities.

NRS 449A.251 Education and training of members of staff of facility.

NRS 449A.254 Violations: Criminal penalties; ineligibility for employment; disciplinary action.

NRS 449A.257 Violations: Report required; development and review of and compliance with corrective plan.

NRS 449A.260 Prohibition on retaliation against person for reporting or providing information regarding violation.

NRS 449A.263 Entry of denial of rights in patient’s record; notice and report of denial; action by Division.

ADDITIONAL PROVISIONS GOVERNING RESIDENTIAL FACILITIES FOR GROUPS

NRS 449A.270 Definitions.

NRS 449A.272 “Emergency” defined.

NRS 449A.274 “Representative of the resident” defined.

NRS 449A.276 “Resident” defined.

NRS 449A.278 Prohibition on certain persons serving as representative of resident; exception.

NRS 449A.280 Required provisions of contract for delivery of services.

NRS 449A.282 Limitations on transfer or involuntary discharge; opportunity to cure delinquency; duty to attempt to resolve circumstances with potential to result in involuntary discharge.

NRS 449A.284 Notices concerning discharge of resident.

NRS 449A.286 Assistance to and consultation with resident concerning discharge.

DESIGNATION OF CAREGIVERS

NRS 449A.300 Definitions.

NRS 449A.303 “Aftercare” defined.

NRS 449A.306 “Caregiver” defined.

NRS 449A.309 “Representative of the patient” defined.

NRS 449A.312 Designation of caregiver for a patient, removal of designation and designation of new caregiver under certain circumstances; designation does not establish obligation to patient.

NRS 449A.315 Hospital to provide opportunity to designate caregiver for patient before discharge or when patient regains competence.

NRS 449A.318 Hospital to record designation or change of caregiver and request consent to release medical information to caregiver if required; hospital to record declination to designate caregiver.

NRS 449A.321 Hospital to attempt to notify caregiver before planned discharge or transfer of patient.

NRS 449A.324 Hospital to attempt to provide caregiver with discharge plan; contents of discharge plan; hospital to attempt to consult with caregiver regarding aftercare.

NRS 449A.327 Hospital to document certain actions and instructions in medical record of patient; hospital to proceed with planned discharge or transfer of patient if unable to reach caregiver.

NRS 449A.330 Hospital and employees and contractors of hospital not liable for aftercare provided improperly or not provided by caregiver.

WITHHOLDING OR WITHDRAWAL OF LIFE-SUSTAINING TREATMENT

NRS 449A.400 Short title; uniformity of application and construction.

NRS 449A.403 Definitions.

NRS 449A.406 “Advanced practice registered nurse” defined.

NRS 449A.409 “Attending advanced practice registered nurse” defined.

NRS 449A.412 “Attending physician” defined.

NRS 449A.415 “Declaration” defined.

NRS 449A.418 “Life-sustaining treatment” defined.

NRS 449A.421 “Person” defined.

NRS 449A.424 “Provider of health care” defined.

NRS 449A.427 “Qualified patient” defined.

NRS 449A.430 “Terminal condition” defined.

NRS 449A.433 Declaration relating to use of life-sustaining treatment.

NRS 449A.436 Form of declaration directing physician or advanced practice registered nurse to withhold or withdraw life-sustaining treatment.

NRS 449A.439 Form of declaration designating another person to decide to withhold or withdraw life-sustaining treatment.

NRS 449A.442 Time declaration becomes operative; duty of providers of health care.

NRS 449A.445 Revocation of declaration; entry of revocation in medical records of declarant.

NRS 449A.448 Recording determination of terminal condition and declaration.

NRS 449A.451 Treatment of qualified patients; withholding or withdrawal of artificial nutrition and hydration; treatment of pregnant patient.

NRS 449A.454 Written consent to withhold or withdraw life-sustaining treatment.

NRS 449A.457 Transfer of care of declarant.

NRS 449A.460 Immunity from civil and criminal liability and discipline for unprofessional conduct.

NRS 449A.463 Consideration of declaration and other factors; failure to follow directions of patient.

NRS 449A.466 Assumption of validity of declaration; presumption of intent to use, withhold or withdraw life-sustaining treatment not created.

NRS 449A.469 Death does not constitute suicide or homicide; effect of declaration on policy of insurance; prohibiting or requiring execution of declaration prohibited as condition for insurance or receipt of health care.

NRS 449A.472 Penalties.

NRS 449A.475 Actions contrary to reasonable medical standards not required; mercy-killing, assisted suicide or euthanasia not authorized.

NRS 449A.478 Other right or responsibility regarding use of life-sustaining treatment or withholding or withdrawal of medical care not limited.

NRS 449A.481 Validity of declaration executed in another state; effect of previously executed instrument.

PROVIDER ORDERS FOR LIFE-SUSTAINING TREATMENT

NRS 449A.500 Definitions.

NRS 449A.503 “Advanced practice registered nurse” defined.

NRS 449A.506 “Attending advanced practice registered nurse” defined.

NRS 449A.509 “Attending physician” defined.

NRS 449A.512 “Attending physician assistant” defined.

NRS 449A.515 “Do-not-resuscitate identification” defined.

NRS 449A.518 “Do-not-resuscitate order” defined.

NRS 449A.521 “Emergency care” defined.

NRS 449A.524 “Health care facility” defined.

NRS 449A.527 “Life-resuscitating treatment” defined.

NRS 449A.530 “Life-sustaining treatment” defined.

NRS 449A.533 “Other types of advance directives” defined.

NRS 449A.536 “Physician assistant” defined.

NRS 449A.539 “Provider of health care” defined.

NRS 449A.542 “Provider Order for Life-Sustaining Treatment form” or “POLST form” defined.

NRS 449A.545 “Representative of the patient” defined.

NRS 449A.548 Board to prescribe standardized POLST form; requirements.

NRS 449A.551 Explanation of POLST form to patient; completion of form; validity of form; actions authorized for patient who regains capacity.

NRS 449A.554 Revocation of POLST form; entry of revocation in medical records of patient.

NRS 449A.557 Conflict with other advance directive or do-not-resuscitate identification.

NRS 449A.560 Immunity from civil and criminal liability and from discipline for unprofessional conduct.

NRS 449A.563 Provider of health care required to comply with valid POLST form; modification by provider; transfer of care of patient; exceptions.

NRS 449A.566 Assumption of validity of POLST form; presumption of intent of patient not created if patient has revoked or not executed POLST form.

NRS 449A.569 Death does not constitute suicide or homicide; effect of POLST form on policy of insurance; prohibiting or requiring execution of POLST form prohibited as condition for insurance or receipt of health care.

NRS 449A.572 Unlawful acts; penalty.

NRS 449A.575 Actions contrary to reasonable medical standards not required; mercy-killing, euthanasia or assisted suicide not authorized; rights associated with other advance directives not impaired; right to make decisions concerning emergency care or life-sustaining treatment not affected.

NRS 449A.578 Validity of POLST form executed in another state.

NRS 449A.581 Regulations.

ADVANCE DIRECTIVES FOR PSYCHIATRIC CARE

NRS 449A.600 Definitions.

NRS 449A.603 “Advance directive for psychiatric care” or “advance directive” defined.

NRS 449A.606 “Attending physician” defined.

NRS 449A.609 “Principal” defined.

NRS 449A.612 “Provider of health care” defined.

NRS 449A.615 “Psychiatric care” defined.

NRS 449A.618 Execution of advance directive; period of effectiveness.

NRS 449A.621 Form.

NRS 449A.624 Requirements for advance directive to become operative; effect.

NRS 449A.627 No presumption concerning intention of person without advance directive.

NRS 449A.630 Provider to make advance directive part of principal’s medical record.

NRS 449A.633 Revocation.

NRS 449A.636 Provider to comply with advance directive; exceptions.

NRS 449A.639 Transfer of care of principal.

NRS 449A.642 Provider to inquire whether person has advance directive for psychiatric care; immunity from liability for certain actions relating to advance directive.

NRS 449A.645 Validity of advance directive executed in another state or instrument executed before May 26, 2017.

REGISTRY OF ADVANCE DIRECTIVES FOR HEALTH CARE

NRS 449A.700 Definitions.

NRS 449A.703 “Advance directive” defined.

NRS 449A.706 “Registrant” defined.

NRS 449A.709 “Registry” defined.

NRS 449A.712 Establishment and maintenance; information to be included in Registry.

NRS 449A.715 Registration of advance directive: Requirements; duties of Secretary of State.

NRS 449A.718 Access to advance directive.

NRS 449A.721 Removal of advance directive of deceased registrant.

NRS 449A.724 Secretary of State not required to determine accuracy of contents of advance directive or validity of advance directive; effect of registration, failure to register and failure to notify Secretary of State of revocation of advance directive.

NRS 449A.727 Provider of health care not required to inquire whether patient has registered advance directive or access Registry; immunity of provider of health care from criminal and civil liability.

NRS 449A.730 Immunity of Secretary of State and deputies, employees and attorneys of Secretary of State.

NRS 449A.733 Suspension of components of Registry and duties of Secretary of State if sufficient money not available; fees authorized; acceptance of gifts and grants.

NRS 449A.736 Deposit, accounting and use of money received; interest and income earned on money received; payment of claims.

NRS 449A.739 Regulations.

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GENERAL PROVISIONS

NRS 449A.001 Definitions. As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 449A.007 to 449A.081, 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; 2011, 1337; 2013, 3055; 2015, 2160, 2172; 2017, 1409, 1570; 2021, 3443; 2023, 718)

NRS 449A.007 “Board” defined. “Board” means the State Board of Health.

(Added to NRS by 1985, 1735)

NRS 449A.017 “Division” defined. “Division” means the Division of Public and Behavioral Health of the Department of Health and Human Services.

(Added to NRS by 2013, 3055)

NRS 449A.031 “Facility for the dependent” defined. “Facility for the dependent” has the meaning ascribed to it in NRS 449.0045.

(Added to NRS by 1985, 1735; A 2001, 2518; 2005, 2165, 2350; 2011, 356; 2015, 2160, 2172; 2019, 250)

NRS 449A.045 “Hospital” defined. “Hospital” means an establishment for the diagnosis, care and treatment of human illness, including care available 24 hours each day from persons licensed to practice professional nursing who are under the direction of a physician, services of a medical laboratory and medical, radiological, dietary and pharmaceutical services.

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

NRS 449A.050 “Medical facility” defined. “Medical facility” has the meaning ascribed to it in NRS 449.0151.

(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; 2021, 3443)

NRS 449A.064 “Provider of health care” defined. “Provider of health care” has the meaning ascribed to it in NRS 629.031.

(Added to NRS by 1995, 1600)

NRS 449A.071 “Registered nurse” defined. “Registered nurse” has the meaning ascribed to it in NRS 632.019.

(Added to NRS by 2005, 1517)

NRS 449A.074 “Residential facility for groups” defined. “Residential facility for groups” has the meaning ascribed to it in NRS 449.017.

(Added to NRS by 2023, 715)

NRS 449A.081 “Terminally ill” defined. “Terminally ill” means a medical diagnosis made by a physician that a person has an anticipated life expectancy of not more than 12 months.

(Added to NRS by 2005, 485)

PATIENTS’ RIGHTS

NRS 449A.100 Facility to provide necessary services or arrange for transfer of patient; explanation of need for transfer and alternatives available.

1. Every medical facility and facility for the dependent must provide the services necessary to treat properly a patient in a particular case or must be able to arrange the transfer of the patient to another facility which can provide that care.

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

(Added to NRS by 1983, 820; A 1985, 1747; 1999, 1051; 2011, 360)

NRS 449A.103 Facility to forward medical records upon certain transfers of patient.

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

2. As used in this section:

(a) “Division facility” means any unit or subunit operated by a division of the Department of Health and Human Services pursuant to title 39 of NRS.

(b) “Medical records” includes a medical history of the patient, a summary of the current physical condition of the patient and a discharge summary which contains the information necessary for the proper treatment of the patient.

(Added to NRS by 1991, 2349; A 1993, 2725; 1999, 1051; 2011, 360)

NRS 449A.106 Specific rights: Information concerning facility; treatment; billing; visitation. Every patient of a medical facility or facility for the dependent has the right to:

1. Receive information concerning any other medical or educational facility or facility for the dependent associated with the facility at which he or she is a patient which relates to the care of the patient.

2. Obtain information concerning the professional qualifications or associations of the persons who are treating the patient.

3. Receive the name of the person responsible for coordinating the care of the patient in the facility.

4. Be advised if the facility in which he or she is a patient proposes to perform experiments on patients which affect the patient’s own care or treatment.

5. Receive from his or her physician a complete and current description of the patient’s diagnosis, plan for treatment and prognosis in terms which the patient is able to understand. If it is not medically advisable to give this information to the patient, the physician shall:

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

(b) Inform that person that he or she shall not disclose the information to the patient.

6. Receive from his or her physician the information necessary for the patient to give his or her informed consent to a procedure or treatment. Except in an emergency, this information must not be limited to a specific procedure or treatment and must include:

(a) A description of the significant medical risks involved;

(b) Any information on alternatives to the treatment or procedure if the patient requests that information;

(d) The costs likely to be incurred for the treatment or procedure and any alternative treatment or procedure.

7. Examine the bill for his or her care and receive an explanation of the bill, whether or not the patient is personally responsible for payment of the bill.

8. Know the regulations of the facility concerning his or her conduct at the facility.

9. Receive, within reasonable restrictions as to time and place, visitors of the patient’s choosing, including, without limitation, friends and members of the patient’s family.

(Added to NRS by 1983, 820; A 1985, 906, 1748; 1999, 1052; 2001, 3047; 2011, 360)

NRS 449A.109 Specific rights: Designation of persons authorized to visit patient in facility.

1. If, as a result of the incapacitation of a patient or the inability of a patient to communicate, the patient of a medical facility or facility for the dependent who is 18 years of age or older is unable to inform the staff of the facility of the persons whom the patient authorizes to visit the patient at the facility, the facility shall allow visitation rights to any person designated by the patient in a letter, form or other document authorizing visitation executed in accordance with subsection 2. The visitation rights required by this subsection must be:

(a) Provided in accordance with the visitation policies of the facility; and

(b) The same visitation rights that are provided to a member of the patient’s family who is legally related to the patient.

2. A person 18 years of age or older wishing to designate a person for the purposes of establishing visitation rights in a medical facility or facility for the dependent may execute a letter, form or other document authorizing visitation in substantially the following form:

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

I, ..............................., (patient who is designating another person as having visitation rights of the patient) do hereby designate .................................. (person who is being designated as having visitation rights of the patient) as having the right to visit me in a medical facility or facility for the dependent. I hereby instruct all staff of a medical facility or facility for the dependent in which I am a patient to admit ...................................... (person who is being designated as having visitation rights of the patient) to my room and afford him or her the same visitation rights as are provided to members of my family who are legally related to me during my time as a patient.

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

(Signed)

(Added to NRS by 2003, 1879; A 2011, 361)

NRS 449A.112 Specific rights: Care; refusal of treatment and experimentation; privacy; notice of appointments and need for care; confidentiality of information concerning patient.

1. Every patient of a medical facility or facility for the dependent has the right to:

(a) Receive considerate and respectful care.

(b) Refuse treatment to the extent permitted by law and to be informed of the consequences of that refusal.

(d) Retain his or her privacy concerning the patient’s program of medical care.

(e) Have any reasonable request for services reasonably satisfied by the facility considering its ability to do so.

(f) Receive continuous care from the facility. The patient must be informed:

(1) Of the patient’s appointments for treatment and the names of the persons available at the facility for those treatments; and

(2) By his or her physician or an authorized representative of the physician, of the patient’s need for continuing care.

2. Except as otherwise provided in NRS 108.640, 239.0115, 439.597, 442.300 to 442.330, inclusive, and 449A.103 and chapter 629 of NRS, discussions of the care of a patient, consultation with other persons concerning the patient, examinations or treatments, and all communications and records concerning the patient are confidential. The patient must consent to the presence of any person who is not directly involved with the patient’s care during any examination, consultation or treatment.

(Added to NRS by 1983, 821; A 1985, 1748; 1989, 2057; 1991, 2350; 1999, 1052, 3512; 2007, 1979, 2110; 2011, 362)

1. Except as otherwise provided in subsection 2, before a facility for intermediate care, facility for skilled nursing or residential facility for groups transfers a patient to another medical facility or facility for the dependent or discharges the patient or resident from the facility, the facility shall:

(a) At least 30 calendar days before transferring or discharging the patient, provide the patient and the Ombudsman with written notice of the intent to transfer or discharge the patient; and

(b) Within 10 calendar days after providing written notice to the patient or resident and the Ombudsman pursuant to paragraph (a), allow the patient and any person authorized by the patient the opportunity to meet in person with the administrator of the facility to discuss the proposed transfer or discharge.

2. The provisions of this section do not apply to:

(a) A voluntary discharge or transfer of a patient to another medical facility or facility for the dependent at the request of the patient; or

(b) The transfer of a patient to another facility because the condition of the patient necessitates an immediate transfer to a facility for a higher level of care.

3. As used in this section:

(a) “Facility for intermediate care” has the meaning ascribed to it in NRS 449.0038.

(b) “Facility for skilled nursing” has the meaning ascribed to it in NRS 449.0039.

(Added to NRS by 2019, 440; A 2021, 3443; 2023, 718)

NRS 449A.115 Owner and administrator of certain facility prohibited from receiving certain money or property from resident or former resident; exception.

1. Except as otherwise provided in subsection 3 and notwithstanding any other provision of law, an owner or administrator of a medical facility or facility for the dependent is not entitled to receive, and must not receive:

(a) Any money, personal property or real property that is devised or bequeathed by will to the owner or administrator by a resident or former resident of the facility.

(b) Any proceeds from a life insurance policy upon the life or body of a resident or former resident of the facility.

2. Except as otherwise provided in subsection 3, any money, property, proceeds or interest therein that is described in subsection 1 passes in accordance with law as if the owner or administrator of the medical facility or facility for the dependent had predeceased the decedent resident or former resident.

3. The provisions of subsections 1 and 2 do not apply if the owner or administrator of the medical facility or facility for the dependent is the spouse, legal guardian or next of kin of the resident or former resident of the facility or home, as applicable.

(Added to NRS by 2011, 696)

NRS 449A.118 Patient to be informed of rights upon admission to facility; required disclosures and notices.

1. Every medical facility and facility for the dependent shall inform each patient or the patient’s legal representative, upon the admission of the patient to the facility, of the patient’s rights as listed in NRS 449A.100 and 449A.106 to 449A.115, inclusive.

2. In addition to the requirements of subsection 1, if a person with a disability is a patient at a facility, as that term is defined in NRS 449A.218, the facility shall inform the patient of his or her rights pursuant to NRS 449A.200 to 449A.263, inclusive.

3. In addition to the requirements of subsections 1 and 2, every hospital shall, upon the admission of a patient to the hospital, provide to the patient or the patient’s legal representative:

(a) Notice of the right of the patient to:

(1) Designate a caregiver pursuant to NRS 449A.300 to 449A.330, inclusive; and

(2) Express complaints and grievances as described in paragraphs (b) to (f), inclusive;

(b) The name and contact information for persons to whom such complaints and grievances may be expressed, including, without limitation, a patient representative or hospital social worker;

(d) The name and contact information of any entity responsible for accrediting the hospital;

(e) A written disclosure approved by the Director of the Department of Health and Human Services, which written disclosure must set forth:

(1) Notice of the existence of the Bureau for Hospital Patients created pursuant to NRS 232.462;

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

(3) An explanation of the services provided by the Bureau, including, without limitation, the services for dispute resolution described in subsection 3 of NRS 232.462; and

(f) Contact information for any other state or local entity that investigates complaints concerning the abuse or neglect of patients.

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

(a) If the hospital is a major hospital:

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

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

(b) If the hospital is not a major hospital, notice of any policies and procedures the hospital may have adopted to reduce charges for services provided to persons or to provide discounted services to persons. The notice required by this paragraph must describe the criteria a patient must satisfy to qualify for the reduction or discount, including, without limitation, any relevant limitations on income and any relevant requirements as to the period within which the patient must arrange to make payment.

Ê As used in this subsection, “major hospital” has the meaning ascribed to it in NRS 439B.115.

5. In addition to the requirements of subsections 1 to 4, inclusive, every hospital shall post in a conspicuous place in each public waiting room in the hospital a legible sign or notice in 14-point type or larger, which sign or notice must:

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

(1) Instructions for receiving additional information regarding such policies and procedures; and

(2) Instructions for arranging to make payment;

(b) Be written in language that is easy to understand; and

(Added to NRS by 1983, 822; A 1985, 1749; 1999, 1053, 3252; 2003, 1880; 2005, 947; 2011, 362, 697; 2019, 537)

NRS 449A.119 Provision of information by off-campus location of hospital where emergency room services are provided.

1. An off-campus location shall post conspicuously in each location where patients are admitted and registered a sign, in not less than 24 point boldface type, which states in English and Spanish:

NOTICE

This is an emergency medical facility that treats emergency medical conditions. You will be charged for a visit to an emergency room and not for a visit to an urgent care center.

2. An off-campus location shall provide to each patient of the emergency department of the off-campus location and any adult accompanying such a patient who is less than 18 years of age immediately upon registration a written statement in substantially the following form:

PATIENT INFORMATION

This is an emergency medical facility that treats emergency medical conditions. You will be charged for a visit to an emergency room and not for a visit to an urgent care center.

We will screen and treat you regardless of your ability to pay.

You have the right to ask questions regarding your treatment options and costs.

You have the right to receive prompt and reasonable responses to such questions and requests.

You have the right to reject treatment.

This is not a complete statement of patient information or rights. You will receive a more comprehensive statement after the completion of a medical screening examination that does not reveal an emergency medical condition or after your emergency medical condition has been stabilized.

3. To the extent practicable, a written statement provided pursuant to subsection 2 must be in the language requested by the patient or the adult accompanying the patient, as applicable.

4. After the completion of an appropriate medical screening examination of a patient of the emergency department of the off-campus location that does not reveal an emergency medical condition or after stabilizing the emergency medical condition of such a patient, an off-campus location shall provide the patient and, if the patient, is less than 18 years of age, any adult accompanying the patient, with written notice of:

(a) The policies of the off-campus location concerning the acceptance of patients enrolled in Medicaid and Medicare;

(b) The networks of third parties in which the off-campus location participates;

(d) The maximum price for emergency medical services that the off-campus location commonly provides; and

(e) Any additional fees that the off-campus location charges.

5. As used in this section:

(a) “Network” means a defined set of providers of health care who are under contract with a third party to provide health care services to persons covered by the third party.

(b) “Off-campus location” means a facility:

(1) With operations that are directly or indirectly owned or controlled by, in whole or in part, a hospital or which is affiliated with a hospital, regardless of whether it is operated by the same governing body as the hospital;

(2) That is located more than 250 yards from the main campus of the hospital;

(3) That provides services which are organizationally and functionally integrated with the hospital; and

(4) That is an outpatient facility providing emergency room services.

(c) “Third party” means any insurer, governmental entity or other organization providing health coverage or benefits in accordance with state or federal law.

(Added to NRS by 2023, 2023)

NRS 449A.121 Procedure to insert implant in breast of patient: Informed consent required; withdrawal of consent; penalty.

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

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

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

(1) The patient if he or she is 18 years of age or over or legally emancipated and competent to give that consent, and from the patient’s legal guardian, if any;

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

(3) The legal guardian of a patient of any age who has been adjudicated mentally incapacitated,

Ê and the required consent was not withdrawn pursuant to subsection 3 before the procedure began.

2. An informed consent requires that the person whose consent is sought be adequately informed as to:

(a) The nature and consequences of the procedure;

(b) The reasonable risks, possible side effects, benefits and purposes of the procedure; and

3. The consent of a patient or other person whose consent is required pursuant to paragraph (b) of subsection 1 may be withdrawn in writing at any time before the procedure has begun, with or without cause.

4. A physician satisfies the requirements of:

(a) Paragraph (a) of subsection 1 if the physician provides the patient and any other person whose consent is required pursuant to paragraph (b) of subsection 1 with a copy of the current explanation form prepared by the Division pursuant to NRS 449A.124 in a language that the person is able to read.

(b) Paragraph (b) of subsection 1 if the person or persons whose consent is required sign a copy of the current consent form prepared by the Division pursuant to NRS 449A.124 freely and without coercion and the consent is not withdrawn pursuant to subsection 3 before the procedure has begun. The consent form must be in a language that the person who signs the form is able to read.

5. Any person who violates the provisions of this section is guilty of a misdemeanor.

(Added to NRS by 1991, 1690)

NRS 449A.124 Procedure to insert implant in breast of patient: Contents of explanation form and consent form; fee for forms.

1. The Division shall prepare and provide to physicians upon request:

(a) An explanation form for a procedure to insert an implant in the breast of a person which includes:

(1) An explanation of the advantages, disadvantages and risks associated with a procedure to insert an implant in the breast of a person, including any known side effects; and

(2) Any other information the Division determines to be useful to a person contemplating a procedure to insert an implant in the breast; and

(b) A consent form for a procedure to insert an implant in the breast of a person which includes:

(1) The nature and consequences of the procedure;

(2) The reasonable risks, possible side effects, benefits and purposes of the procedure; and

(3) Any alternative procedures available.

2. The Division shall revise the explanation form and consent form as necessary to keep the medical information current.

3. The Division shall charge and collect a fee for all forms distributed pursuant to this section that is adequate to cover the cost of producing the forms.

(Added to NRS by 1991, 1690)

COLLECTION OF AMOUNT OWED FOR HOSPITAL CARE

NRS 449A.150 Definitions. As used in NRS 449A.150 to 449A.165, inclusive, unless the context otherwise requires, the words and terms defined in NRS 449A.153 and 449A.156 have the meanings ascribed to them in those sections.

(Added to NRS by 2007, 1497; A 2011, 1524)

NRS 449A.153 “Hospital care” defined. “Hospital care” has the meaning ascribed to it in NRS 428.155.

(Added to NRS by 2007, 1497)

NRS 449A.156 “Responsible party” defined. “Responsible party” means the person who received the hospital care, the parent or guardian of the person who received the hospital care or another natural person who is legally responsible or has agreed to be responsible for the payment to the hospital of any charges incurred in connection with the hospital care.

(Added to NRS by 2007, 1497)

NRS 449A.159 Limitations on efforts of hospitals to collect; date for accrual of interest; rate of interest; limitations on additional fees.

1. When a person receives hospital care, the hospital must not proceed with any efforts to collect on any amount owed to the hospital for the hospital care from the responsible party, other than for any copayment or deductible, if the responsible party has health insurance or may be eligible for Medicaid, the Children’s Health Insurance Program or any other public program which may pay all or part of the bill, until the hospital has submitted a bill to the health insurance company or public program and the health insurance company or public program has made a determination concerning payment of the claim.

2. Collection efforts may begin and interest may begin to accrue on any amount owed to the hospital for hospital care which remains unpaid by the responsible party not sooner than 30 days after the responsible party is sent a bill by mail stating the amount that he or she is responsible to pay which has been established after receiving a determination concerning payment of the claim by any insurer or public program and after applying any discounts. Interest must accrue at a rate which does not exceed the prime rate at the largest bank in Nevada as ascertained by the Commissioner of Financial Institutions on January 1 or July 1, as the case may be, immediately preceding the date on which the payment becomes due, plus 2 percent. The rate must be adjusted accordingly on each January 1 and July 1 thereafter until the payment is satisfied.

3. Except for the interest authorized pursuant to subsection 2 and any court costs and attorney’s fees awarded by a court, no other fees may be charged concerning the amount that remains unpaid, including, without limitation, collection fees, other attorney’s fees or any other fees or costs.

(Added to NRS by 2007, 1497; A 2011, 1525)

1. Except as otherwise provided in subsection 3, if a hospital provides hospital care to a person who has a policy of health insurance issued by a third party that provides health coverage for care provided at that hospital and the hospital has a contractual agreement with the third party, the hospital:

(a) Shall proceed with any efforts to collect on any amount owed to the hospital for the hospital care in accordance with the provisions of NRS 449A.159.

(b) Shall not collect or attempt to collect from the patient or other responsible party more than the sum of the amounts of any deductible, copayment or coinsurance payable by or on behalf of the patient under the policy of health insurance.

(1) Any proceeds or potential proceeds of a civil action brought by or on behalf of the patient, including, without limitation, any amount awarded for medical expenses; or

(2) An insurer other than an insurer that provides coverage under a policy of health insurance or an insurer that provides coverage for medical payments under a policy of casualty insurance.

2. If the hospital collects or receives any payments from an insurer that provides coverage for medical payments under a policy of casualty insurance, the hospital shall, not later than 30 days after a determination is made concerning coverage, return to the patient any amount collected or received that is in excess of the deductible, copayment or coinsurance payable by or on behalf of the patient under the policy of health insurance.

3. This section does not apply to:

(a) Amounts owed to the hospital which are not covered under the policy of health insurance; or

(b) Medicaid, Medicare, the Children’s Health Insurance Program or any other public program which may pay all or part of the bill.

4. This section does not limit any rights of a patient to contest an attempt to collect an amount owed to a hospital, including, without limitation, contesting a lien obtained by a hospital.

5. As used in this section, “third party” means:

(a) An insurer, as defined in NRS 679B.540;

(b) A health benefit plan, as defined in NRS 687B.470, for employees which provides coverage for services and care at a hospital;

(c) A participating public agency, as defined in NRS 287.04052, and any other local governmental agency of the State of Nevada which provides a system of health insurance for the benefit of its officers and employees, and the dependents of officers and employees, pursuant to chapter 287 of NRS; or

(d) Any other insurer or organization providing health coverage or benefits in accordance with state or federal law.

(Added to NRS by 2011, 1524; A 2017, 4115; 2019, 1109)

(a) Shall proceed with any efforts to collect on any amount owed to the hospital for the hospital care in accordance with the provisions of NRS 449A.159.

(1) Any proceeds or potential proceeds of a civil action brought by or on behalf of the patient, including, without limitation, any amount awarded for medical expenses; or

(2) An insurer other than an insurer that provides coverage under a policy of health insurance or an insurer that provides coverage for medical payments under a policy of casualty insurance.

3. This section does not apply to:

(a) Amounts owed to the hospital which are not covered under the policy of health insurance; or

(b) Medicaid, Medicare, the Children’s Health Insurance Program or any other public program which may pay all or part of the bill.

4. This section does not limit any rights of a patient to contest an attempt to collect an amount owed to a hospital, including, without limitation, contesting a lien obtained by a hospital.

5. As used in this section, “third party” means:

(a) An insurer, as defined in NRS 679B.540;

(b) A health benefit plan, as defined in NRS 687B.470, for employees which provides coverage for services and care at a hospital;

(d) The Public Option established pursuant to NRS 695K.200; or

(e) Any other insurer or organization providing health coverage or benefits in accordance with state or federal law.

(Added to NRS by 2011, 1524; A 2017, 4115; 2019, 1109; 2021, 3644, effective January 1, 2026)

NRS 449A.165 Manner of collection. A hospital, or any person acting on its behalf who seeks to collect a debt from a responsible party for any amount owed to the hospital for hospital care must collect the debt in a professional, fair and lawful manner. When collecting such a debt, the hospital or other person acting on its behalf must act in accordance with sections 803 to 812, inclusive, of the federal Fair Debt Collection Practices Act, as amended, 15 U.S.C. §§ 1692a to 1692j, inclusive, even if the hospital or person acting on its behalf is not otherwise subject to the provisions of that Act.

(Added to NRS by 2007, 1498)

INSTALLATION AND USE OF ELECTRONIC COMMUNICATION DEVICES IN FACILITIES FOR SKILLED NURSING

NRS 449A.170 Definitions. As used in NRS 449A.170 to 449A.192, inclusive, unless the context otherwise requires, the words and terms defined in NRS 449A.172 to 449A.178, inclusive, have the meanings ascribed to them in those sections.

(Added to NRS by 2023, 1372)

NRS 449A.172 “Facility for skilled nursing” defined. “Facility for skilled nursing” has the meaning ascribed to it in NRS 449.0039.

(Added to NRS by 2023, 1372)

NRS 449A.174 “Guardian” defined. “Guardian” has the meaning ascribed to it in NRS 159.017.

(Added to NRS by 2023, 1372)

NRS 449A.176 “Living quarters” defined. “Living quarters” means the room in which a patient resides.

(Added to NRS by 2023, 1372)

NRS 449A.178 “Representative” defined. “Representative” means a person who is authorized to serve as the representative of a patient pursuant to NRS 449A.180.

(Added to NRS by 2023, 1372)

NRS 449A.180 Requirements for representative of patient. A person may serve as the representative of a patient in a facility for skilled nursing, including, without limitation, a patient who is the roommate of a patient who wishes to submit or has submitted a request pursuant to NRS 449A.182, for the purposes of NRS 449A.170 to 449A.192, inclusive, if the person:

1. Is the guardian of the patient whom he or she is representing and:

(a) The power to make decisions on behalf of the patient pursuant to NRS 449A.170 to 449A.192, inclusive, is specifically authorized under the existing guardianship; or

(b) The guardian has separately petitioned for and been granted such power by the court that has jurisdiction over the guardianship; or

2. Has been given power of attorney to make decisions concerning health care for the patient pursuant to NRS 162A.700 to 162A.870, inclusive, and the power to make decisions on behalf of the patient pursuant to NRS 449A.170 to 449A.192, inclusive, is specifically delegated to the person in the power of attorney.

(Added to NRS by 2023, 1372)

NRS 449A.182 Request for installation and use: Contents; form; approval; facility to attempt to accommodate patient if roommate refuses consent; withdrawal.

1. A patient in a facility for skilled nursing or the representative of the patient may request the installation and use of an electronic communication device in the living quarters of the patient by submitting to the facility for skilled nursing:

(a) A completed form prescribed by the facility pursuant to subsection 3; or

(b) If the facility has not prescribed a form pursuant to subsection 3, a written request that meets the requirements of subsection 2.

2. A request submitted pursuant to subsection 1 must include or be accompanied by:

(a) Information regarding the type, function and expected use of the electronic communication device which will be installed and used;

(b) The name and contact information for any person other than the patient or his or her representative who is authorized to view or listen to the images or sounds which are displayed, broadcast or recorded by the electronic communication device pursuant to subsection 3 of NRS 449A.186;

(1) Waive the patient’s right to privacy in connection with use of the electronic communication device; and

(2) Release the facility for skilled nursing and any employee of the facility from any administrative, civil or criminal liability for a violation of the patient’s right to privacy in connection with use of the electronic communication device;

(d) If the patient has a roommate:

(1) The written consent of the roommate or the representative of the roommate to the installation and use of an electronic communication device in the living quarters of the patient; and

(2) An agreement by the roommate or the representative of the roommate to, except as otherwise provided in NRS 449A.186:

(I) Waive the roommate’s right to privacy in connection with use of the electronic communication device; and

(II) Release the facility for skilled nursing and any employee of the facility from any administrative, civil or criminal liability for a violation of the roommate’s right to privacy in connection with the use of the electronic communication device; and

(e) If the request is submitted by the representative of the patient, proof that the representative of the patient meets the requirements of NRS 449A.180.

3. A facility for skilled nursing may prescribe a form for use by a patient or the representative of a patient to request to install and use an electronic communication device in the living quarters of the patient. To the extent practicable, such a form must be provided in a language chosen by the patient or the representative of the patient. Such a form must include, without limitation:

(a) An explanation of the provisions of NRS 449A.170 to 449A.192, inclusive; and

(b) Places to record the information, agreements and consent described in paragraphs (a) to (d), inclusive, of subsection 2.

4. A facility for skilled nursing shall approve a request by a patient or the representative of a patient pursuant to this section if the request meets the requirements of this section.

5. If the roommate or the representative of the roommate of a patient who wishes to submit a request pursuant to subsection 1, or whose representative wishes to submit such a request, refuses to provide consent and enter into the agreement required by paragraph (d) of subsection 2, the facility for skilled nursing shall make reasonable attempts to accommodate the patient. Such reasonable attempts may include, without limitation, moving either the patient or his or her roommate to different living quarters with the consent of the person being moved or his or her representative.

6. A patient or the representative of a patient who has submitted a request pursuant to subsection 1, a roommate who has provided consent pursuant to paragraph (d) of subsection 2 or the representative of such a roommate may withdraw the request or consent at any time, including, without limitation, after the request has been approved or after an electronic communication device has been installed, by submitting a written revocation to the facility for skilled nursing. Not later than 24 hours after the submission of such a written revocation, the facility for skilled nursing shall cause the removal of any electronic communication device that has been installed.

(Added to NRS by 2023, 1373)

NRS 449A.184 Responsibilities of patient; requirements for device.

1. If a facility for skilled nursing approves a request to install and use an electronic communication device in the living quarters of a patient pursuant to NRS 449A.182, the patient or the representative of the patient is solely responsible for:

(a) Choosing the electronic communication device, subject to the limitations prescribed by subsection 3;

(b) The cost of the electronic communication device;

(c) The cost of installing, maintaining and removing the electronic communication device, if applicable, other than the cost of electricity used to power the electronic communication device; and

(d) The cost of any repairs required due to the installation or removal of the device.

2. A patient who is discharged from a facility for skilled nursing or the representative of such a patient remains solely responsible for the costs described in subsection 1, including, without limitation, such costs that are incurred after the discharge of the patient.

3. An electronic communication device chosen by a patient or the representative of a patient pursuant to subsection 1 must:

(a) Be capable of being temporarily disabled or turned on and off; and

(b) If the device communicates using video or other visual transmission, to the greatest extent practicable, be installed:

(1) With a fixed viewpoint of the living quarters; or

(2) In a manner that avoids capturing images of activities such as bathing, dressing and toileting.

(Added to NRS by 2023, 1374)

NRS 449A.186 Prohibitions; exceptions.

1. Except as otherwise provided in this section, a person other than the patient or the representative of the patient who has requested the installation and use of an electronic communication device pursuant to NRS 449A.182 shall not intentionally:

(a) Obstruct, tamper with or destroy the electronic communication device or any recording made by the electronic communication device; or

(b) View or listen to any images or sounds which are displayed, broadcast or recorded by the electronic communication device.

2. The following persons may view or listen to the images or sounds which are displayed, broadcast or recorded by an electronic communication device installed and used pursuant to NRS 449A.182 or temporarily disable or turn off such a device:

(a) A representative of a law enforcement agency who is conducting an investigation;

(b) A representative of the Aging and Disability Services Division or the Division of Public and Behavioral Health of the Department of Health and Human Services who is conducting an investigation;

(d) An attorney who is representing the patient or a roommate of the patient and acting within the scope of that representation.

3. A patient or the representative of the patient who has requested the installation and use of an electronic communication device pursuant to NRS 449A.182 may authorize a person other than a person described in subsection 2 to view or listen to the images or sounds which are displayed, broadcast or recorded by the electronic communication device. Any such authorization must be made in writing. The patient or representative, as applicable, may provide a copy of the authorization to the facility and the roommate of the patient or the representative of the roommate, if any.

4. A person who temporarily disables or turns off an electronic communication device pursuant to subsection 2 shall ensure that the functions of the electronic communication device are appropriately enabled or turned back on before exiting the living quarters of the patient.

5. A facility for skilled nursing shall not deny admission to or discharge a patient from the facility or otherwise discriminate or retaliate against a patient because of a decision to request the installation and use of an electronic communication device in the living quarters of the patient pursuant to NRS 449A.182.

(Added to NRS by 2023, 1375)

NRS 449A.188 Penalties.

1. A natural person who violates subsection 1 of NRS 449A.186:

(a) For a first offense, is liable for a civil penalty not to exceed $5,000.

(b) For a second and any subsequent offense:

(1) Is liable for a civil penalty not to exceed $10,000 for each violation; and

(2) Is guilty of a misdemeanor.

2. In addition to any disciplinary action imposed pursuant to chapter 449 of NRS, a facility for skilled nursing or any person, partnership, association or corporation establishing, conducting, managing or operating a facility for skilled nursing who violates subsection 1 or 5 of NRS 449A.186:

(a) For a first offense, is liable for a civil penalty not to exceed $10,000.

(b) For a second and any subsequent offense:

(1) Is liable for a civil penalty not to exceed $20,000 for each violation; and

(2) Is guilty of a misdemeanor.

3. The Attorney General or any district attorney may recover any civil penalty assessed pursuant to this section in a civil action brought in the name of the State of Nevada in any court of competent jurisdiction.

(Added to NRS by 2023, 1375)

NRS 449A.190 Facility to post notice where device is in use; employee prohibited from refusing to perform duties because of device.

1. A facility for skilled nursing shall post a notice in a conspicuous place at the entrance to the living quarters of a patient which contains an electronic communication device stating that such a device is in use in that living quarters.

2. An employee of a facility of skilled nursing shall not refuse to enter the living quarters of a patient which contains an electronic communication device installed pursuant to NRS 449A.182 or fail to perform any of the duties of the employee on the grounds that such a device is in use.

(Added to NRS by 2023, 1376)

NRS 449A.192 Regulations; inapplicability where device installed by law enforcement agency.

1. The State Board of Health may adopt regulations necessary to carry out the provisions of NRS 449A.170 to 449A.192, inclusive.

2. The provisions of NRS 449A.170 to 449A.192, inclusive, do not apply if an electronic communication device is installed by a law enforcement agency and used solely for a legitimate law enforcement purpose.

(Added to NRS by 2023, 1376)

USE OF AVERSIVE INTERVENTION OR FORMS OF RESTRAINT ON PATIENTS WITH DISABILITIES

NRS 449A.200 Definitions. As used in NRS 449A.200 to 449A.263, inclusive, unless the context otherwise requires, the words and terms defined in NRS 449A.203 to 449A.230, inclusive, have the meanings ascribed to them in those sections.

(Added to NRS by 1999, 3247)

NRS 449A.203 “Aversive intervention” defined. “Aversive intervention” means any of the following actions if the action is used to punish a person with a disability or to eliminate, reduce or discourage maladaptive behavior of a person with a disability:

1. The use of noxious odors and tastes;

2. The use of water and other mists or sprays;

3. The use of blasts of air;

4. The use of corporal punishment;

5. The use of verbal and mental abuse;

6. The use of electric shock;

7. Requiring a person to perform exercise under forced conditions if the:

(a) Person is required to perform the exercise because the person exhibited a behavior that is related to his or her disability;

(b) Exercise is harmful to the health of the person because of his or her disability; or

8. Any intervention, technique or procedure that deprives a person of the use of one or more of the person’s senses, regardless of the length of the deprivation, including, without limitation, the use of sensory screens; or

9. The deprivation of necessities needed to sustain the health of a person, regardless of the length of the deprivation, including, without limitation, the denial or unreasonable delay in the provision of:

(a) Food or liquid at a time when it is customarily served; or

(b) Medication.

Ê The term does not include the withholding or withdrawal of life-sustaining treatment in accordance with NRS 449A.454 or 449A.500 to 449A.581, inclusive.

(Added to NRS by 1999, 3247; A 2013, 2288)

NRS 449A.206 “Chemical restraint” defined. “Chemical restraint” means the administration of drugs to a person for the specific and exclusive purpose of controlling an acute or episodic behavior that places the person or others at a risk of harm when less restrictive alternative intervention techniques have failed to limit or control the behavior. The term does not include the administration of drugs prescribed by a physician, physician assistant or advanced practice registered nurse as standard treatment for the mental or physical condition of the person.

(Added to NRS by 1999, 3247; A 2021, 3112)

NRS 449A.209 “Corporal punishment” defined. “Corporal punishment” means the intentional infliction of physical pain, including, without limitation, hitting, pinching or striking.

(Added to NRS by 1999, 3248)

NRS 449A.212 “Electric shock” defined. “Electric shock” means the application of electric current to a person’s skin or body. The term does not include electroconvulsive therapy.

(Added to NRS by 1999, 3248)

NRS 449A.215 “Emergency” defined. “Emergency” means a situation in which immediate intervention is necessary to protect the physical safety of a person or others from an immediate threat of physical injury or to protect against an immediate threat of severe property damage.

(Added to NRS by 1999, 3248)

NRS 449A.218 “Facility” defined. “Facility” means a facility licensed pursuant to chapter 449 of NRS that is a psychiatric hospital, as defined in NRS 449.0165, or a unit of a hospital that is specifically designated to provide care and services to persons with psychiatric or developmental disabilities.

(Added to NRS by 1999, 3248; A 2021, 3444)

NRS 449A.221 “Mechanical restraint” defined. “Mechanical restraint” means the use of devices, including, without limitation, mittens, straps and restraint chairs to limit a person’s movement or hold a person immobile.

(Added to NRS by 1999, 3248)

NRS 449A.224 “Person with a disability” defined. “Person with a disability” means a person who:

1. Has a physical or mental impairment that substantially limits one or more of the major life activities of the person;

2. Has a record of such an impairment; or

3. Is regarded as having such an impairment.

(Added to NRS by 1999, 3248)

NRS 449A.227 “Physical restraint” defined. “Physical restraint” means the use of physical contact to limit a person’s movement or hold a person immobile.

(Added to NRS by 1999, 3248)

NRS 449A.230 “Verbal and mental abuse” defined. “Verbal and mental abuse” means actions or utterances that are intended to cause and actually cause severe emotional distress to a person.

(Added to NRS by 1999, 3248)

NRS 449A.233 Aversive intervention: Prohibition on use. A person employed by a facility licensed pursuant to chapter 449 of NRS or any other person shall not use any aversive intervention on a person with a disability who is a patient at the facility.

(Added to NRS by 1999, 3248)

NRS 449A.236 Forms of restraint: Restrictions on use. A person employed by a facility licensed pursuant to chapter 449 of NRS or any other person shall not:

1. Except as otherwise provided in NRS 449A.239, use physical restraint on a person with a disability who is a patient at the facility.

2. Except as otherwise provided in NRS 449A.242, use mechanical restraint on a person with a disability who is a patient at the facility.

3. Except as otherwise provided in NRS 449A.245, use chemical restraint on a person with a disability who is a patient at the facility.

(Added to NRS by 1999, 3248)

NRS 449A.239 Physical restraint: Permissible use; report of use in emergency.

1. Except as otherwise provided in subsection 2, physical restraint may be used on a person with a disability who is a patient at a facility only if:

(a) An emergency exists that necessitates the use of physical restraint;

(b) The physical restraint is used only for the period that is necessary to contain the behavior of the patient so that the patient is no longer an immediate threat of causing physical injury to himself or herself or others or causing severe property damage; and

(c) The use of force in the application of physical restraint does not exceed the force that is reasonable and necessary under the circumstances precipitating the use of physical restraint.

2. Physical restraint may be used on a person with a disability who is a patient at a facility and the provisions of subsection 1 do not apply if the physical restraint is used to:

(a) Assist the patient in completing a task or response if the patient does not resist the application of physical restraint or if the patient’s resistance is minimal in intensity and duration;

(b) Escort or carry a patient to safety if the patient is in danger in his or her present location; or

3. If physical restraint is used on a person with a disability who is a patient at a facility in an emergency, the use of the procedure must be reported as a denial of rights pursuant to NRS 449A.263, regardless of whether the use of the procedure is authorized by statute. The report must be made not later than 1 working day after the procedure is used.

(Added to NRS by 1999, 3249)

NRS 449A.242 Mechanical restraint: 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 patient at a facility only if:

(a) An emergency exists that necessitates the use of mechanical restraint;

(b) A medical order authorizing the use of mechanical restraint is obtained from the patient’s treating physician or advanced practice registered nurse before the application of the mechanical restraint or not later than 15 minutes after the application of the mechanical restraint;

(c) The physician or advanced practice registered nurse who signed the order required pursuant to paragraph (b) or the attending physician or attending advanced practice registered nurse examines the patient not later than 1 working day immediately after the application of the mechanical restraint;

(d) The mechanical restraint is applied by a member of the staff of the facility who is trained and qualified to apply mechanical restraint;

(e) The patient is given the opportunity to move and exercise the parts of his or her body that are restrained at least 10 minutes per every 60 minutes of restraint;

(f) A member of the staff of the facility lessens or discontinues the restraint every 15 minutes to determine whether the patient will stop or control his or her inappropriate behavior without the use of the restraint;

(g) The record of the patient contains a notation that includes the time of day that the restraint was lessened or discontinued pursuant to paragraph (f), the response of the patient and the response of the member of the staff of the facility who applied the mechanical restraint;

(h) A member of the staff of the facility continuously monitors the patient during the time that mechanical restraint is used on the patient; and

(i) The patient is released from the mechanical restraint as soon as the behavior of the patient no longer presents an immediate threat to himself or herself or others.

2. Mechanical restraint may be used on a person with a disability who is a patient at a facility and the provisions of subsection 1 do not apply if the mechanical restraint is used to:

(a) Treat the medical needs of a patient;

(b) Protect a patient who is known to be at risk of injury to himself or herself because the patient lacks coordination or suffers from frequent loss of consciousness;

(d) Position a patient who has physical disabilities in a manner prescribed in the patient’s plan of treatment.

3. If mechanical restraint is used on a person with a disability who is a patient at a facility in an emergency, the use of the procedure must be reported as a denial of rights pursuant to NRS 449A.263, regardless of whether the use of the procedure is authorized by statute. The report must be made not later than 1 working day after the procedure is used.

(Added to NRS by 1999, 3249; A 2017, 1766)

NRS 449A.245 Chemical restraint: Permissible use; report of use.

1. Chemical restraint may only be used on a person with a disability who is a patient at a facility if:

(a) The patient has been diagnosed as a person in a mental health crisis, as defined in NRS 433A.0175, and is receiving mental health services from a facility;

(b) The chemical restraint is administered to the patient while he or she is under the care of the facility;

(d) A medical order authorizing the use of chemical restraint is obtained from the patient’s attending physician, psychiatrist or advanced practice registered nurse;

(e) The physician, psychiatrist or advanced practice registered nurse who signed the order required pursuant to paragraph (d) examines the patient not later than 1 working day immediately after the administration of the chemical restraint; and

(f) The chemical restraint is administered by a person licensed to administer medication.

2. If chemical restraint is used on a person with a disability who is a patient, the use of the procedure must be reported as a denial of rights pursuant to NRS 449A.263, regardless of whether the use of the procedure is authorized by statute. The report must be made not later than 1 working day after the procedure is used.

(Added to NRS by 1999, 3250; A 2017, 1767; 2019, 367)

NRS 449A.248 Authorized use of certain forms of restraint by certain facilities. Notwithstanding the provisions of NRS 449A.236 to 449A.245, inclusive, to the contrary, a facility may use or authorize the use of physical restraint, mechanical restraint or chemical restraint on a person with a disability who is a patient if the facility is:

1. Accredited by a nationally recognized accreditation association or agency; or

2. Certified for participation in the Medicaid or Medicare program,

Ê only to the extent that the accreditation or certification allows the use of such restraint.

(Added to NRS by 1999, 3248)

NRS 449A.251 Education and training of members of staff of facility.

1. Each facility shall develop a program of education for the members of the staff of the facility to provide instruction in positive behavioral interventions and positive behavioral supports that:

(a) Includes positive methods to modify the environment of patients to promote adaptive behavior and reduce the occurrence of inappropriate behavior;

(b) Includes methods to teach skills to patients so that patients can replace inappropriate behavior with adaptive behavior;

(d) Includes the use of the least intrusive methods to respond to and reinforce the behavior of patients; and

(e) Offers a process for designing interventions based upon the patient that are focused on promoting appropriate changes in behavior as well as enhancing the overall quality of life for the patient.

2. Each facility shall provide appropriate training for the members of the staff of the facility who are authorized to carry out and monitor physical restraint and mechanical restraint to ensure that those members of the staff are competent and qualified to carry out the procedures in accordance with NRS 449A.200 to 449A.263, inclusive.

(Added to NRS by 1999, 3250)

NRS 449A.254 Violations: Criminal penalties; ineligibility for employment; disciplinary action.

1. Unless a more severe penalty is prescribed by specific statute, a person who willfully uses aversive intervention on a person with a disability who is a patient at a facility or, except as otherwise provided in NRS 449A.248, violates NRS 449A.236:

(a) For a first violation that does not result in substantial bodily harm to the person with a disability, is guilty of a gross misdemeanor.

(b) For a first violation that results in substantial bodily harm to the person with a disability, is guilty of a category B felony.

Ê A person who is convicted of a category B felony pursuant to this section shall be punished by imprisonment in the state prison for a minimum term of not less than 1 year and a maximum term of not more than 6 years, or by a fine of not more than $5,000, or by both fine and imprisonment.

2. A person who is convicted pursuant to this section is ineligible for 5 years for employment with a facility.

3. A conviction pursuant to this section is, when applicable, grounds for disciplinary action against the person so convicted and the facility where the violation occurred. The Division may recommend to the appropriate agency or board the suspension or revocation of the professional license, registration, certificate or permit of a person convicted.

(Added to NRS by 1999, 3251)

NRS 449A.257 Violations: Report required; development and review of and compliance with corrective plan.

1. A facility where a violation of the provisions of NRS 449A.200 to 449A.263, inclusive, occurs shall report the violation to the Division not later than 24 hours after the violation occurred, or as soon thereafter as the violation is discovered.

2. A facility where a violation occurred shall develop, in cooperation with the Division, a corrective plan to ensure that within 30 calendar days after the violation occurred, appropriate action is taken by the facility to prevent future violations.

3. The Division shall forward the plan to the Board. The Board shall review the plan to ensure that it complies with applicable federal law and the statutes and regulations of this state. The Board may require appropriate revision of the plan to ensure compliance.

4. If the facility where the violation occurred does not meet the requirements of the plan to the satisfaction of the Board, the Board may direct the agency that administers funding for the facility to withhold state funding for the facility until the facility meets the requirements of the plan.

(Added to NRS by 1999, 3251)

NRS 449A.260 Prohibition on retaliation against person for reporting or providing information regarding violation. An officer, administrator or employee of a facility licensed pursuant to this chapter shall not retaliate against any person for having:

1. Reported a violation of NRS 449A.200 to 449A.263, inclusive; or

2. Provided information regarding a violation of NRS 449A.200 to 449A.263, inclusive,

Ê by a facility or a member of the staff of the facility.

(Added to NRS by 1999, 3252)

NRS 449A.263 Entry of denial of rights in patient’s record; notice and report of denial; action by Division.

1. A denial of rights of a person with a disability who is a patient of a facility pursuant to NRS 449A.200 to 449A.263, inclusive, must be entered in the patient’s record. Notice of the denial must be provided to the administrator of the facility.

2. If the administrator of a facility receives notice of a denial of rights pursuant to subsection 1, the administrator shall cause a full report to be prepared which must set forth in detail the factual circumstances surrounding the denial. A copy of the report must be provided to the Division.

3. The Division:

(a) Shall receive reports made pursuant to subsection 2;

(b) May investigate apparent violations of the rights of persons with disabilities who are patients at facilities; and

(Added to NRS by 1999, 3252)

ADDITIONAL PROVISIONS GOVERNING RESIDENTIAL FACILITIES FOR GROUPS

NRS 449A.270 Definitions. As used in NRS 449A.270 to 449A.286, inclusive, unless the context otherwise requires, the words and terms defined in NRS 449A.272, 449A.274 and 449A.276 have the meanings ascribed to them in those sections.

(Added to NRS by 2023, 715)

NRS 449A.272 “Emergency” defined. “Emergency” means circumstances where there is an imminent danger of death or serious physical harm to a resident.

(Added to NRS by 2023, 715)

NRS 449A.274 “Representative of the resident” defined. “Representative of the resident” means a natural person who is designated in writing by a resident to be his or her representative. The term includes, without limitation, a person given power of attorney to make decisions concerning health care for the resident pursuant to NRS 162A.700 to 162A.870, inclusive, or a person appointed as a guardian of the resident under the provisions of chapter 159 of NRS.

(Added to NRS by 2023, 715)

NRS 449A.276 “Resident” defined. “Resident” means a natural person who resides in a residential facility for groups.

(Added to NRS by 2023, 715)

NRS 449A.278 Prohibition on certain persons serving as representative of resident; exception. The owner, agent or employee of a residential facility for groups or a provider of health care must not serve as the representative of a resident for the purposes of NRS 449A.270 to 449A.286, inclusive, unless the owner, agent, employee or provider is related to the resident by consanguinity or affinity within the third degree.

(Added to NRS by 2023, 715)

NRS 449A.280 Required provisions of contract for delivery of services. A contract between a resident and a residential facility for groups for the delivery of services to the resident must:

1. Be entitled “Service Delivery Contract for Residential Facility for Groups”;

2. Be printed in at least 12 point type; and

3. Include, without limitation, the following information in the body of the contract or in a supporting document or attachment:

(a) The name, physical address and mailing address, if different, of the residential facility for groups;

(b) The name and mailing address of every person, partnership, association or corporation which establishes, conducts, manages or operates the residential facility for groups;

(c) The name and address of at least one person who is authorized to accept service on behalf of the parties described in paragraph (b);

(d) A telephone number or the address of the Internet website of:

(1) The Division that the resident or a representative of the resident may use to verify the status of the license of the residential facility for groups; and

(2) Each licensing board or other regulatory body that has issued a license to a provider of health care or other person required to be licensed who provides services to residents at the residential facility for groups that the resident or a representative of the resident may use to verify the status of the license of the provider of health care or other person;

(e) The duration of the contract;

(f) The manner in which the contract may be modified, amended or terminated;

(g) The base rate to be paid by the resident and a description of the services to be provided as part of the base rate;

(h) A fee schedule outlining the cost of any additional services;

(i) Any additional fee to be paid by the resident pursuant to the fee schedule and a description of any additional services to be provided as part of that fee, either directly by the residential facility for groups or by a third-party provider of services under contract with the facility;

(j) A statement affirming the freedom of the resident to receive services from a provider of services with whom the residential facility for groups does not have a contractual arrangement, which may also disclaim liability on the part of the residential facility for groups for any such services;

(k) The procedures and requirements for billing and payment under the contract;

(l) A statement detailing the criteria and procedures for admission, management of risk and termination of residency;

(m) The obligations of the resident in order to maintain residency and receive services, including, without limitation, compliance with the annual physical examination and assessment required by NRS 449.1845;

(n) A description of the process of the residential facility for groups for resolving the complaints of residents and contact information for the Aging and Disability Services Division and the Division of Public and Behavioral Health of the Department of Health and Human Services;

(o) The name and mailing address of any representative of the resident, if applicable; and

(p) Contact information for:

(1) The State Long-Term Care Ombudsman appointed pursuant to NRS 427A.125;

(2) The Nevada Disability Advocacy and Law Center, or its successor organization; or

(3) Other resources for legal aid or mental health assistance, as appropriate.

(Added to NRS by 2023, 715)

NRS 449A.282 Limitations on transfer or involuntary discharge; opportunity to cure delinquency; duty to attempt to resolve circumstances with potential to result in involuntary discharge.

1. A residential facility for groups shall not transfer or involuntarily discharge a resident except where:

(a) The health of the resident has improved sufficiently such that the resident no longer needs the services provided by the residential facility for groups;

(b) The health or safety of any person in the residential facility for groups is endangered;

(c) The resident has failed, after notice has been provided pursuant to subsection 2, to pay for contracted charges for a residency at or a service provided by the residential facility for groups;

(d) The services available to the resident at the residential facility for groups are no longer adequate to meet the needs of the resident, as determined using information from the annual physical examination and assessment conducted pursuant to NRS 449.1845; or

(e) The residential facility for groups ceases to operate.

2. At least 30 days before providing notice of intent to discharge a resident for failure to pay contracted charges pursuant to NRS 449A.114, a residential facility for groups shall notify the resident and any representative of the resident in writing of the delinquency. The facility shall allow the resident or his or her representative, as applicable, at least 15 days after such notice is provided to cure the delinquency.

3. Except as otherwise provided in this subsection, a residential facility for groups shall attempt to resolve with the resident or the representative of the resident, if applicable, any circumstances that, if not remedied, have the potential to result in an involuntary discharge of the resident. The facility shall document any such attempt in the file of the resident. All attempts at resolution pursuant to this subsection must occur before the resident is discharged, but may occur before or after the provision of notice pursuant to NRS 449A.114. A residential facility for groups is not required to comply with the requirements of this subsection in an emergency.

4. A residential facility for groups shall not transfer or involuntarily discharge a resident if such transfer or discharge presents an imminent danger of death to the resident.

(Added to NRS by 2023, 716)

NRS 449A.284 Notices concerning discharge of resident.

1. Written notice of the intent of a residential facility for groups to discharge a resident provided pursuant to NRS 449A.114 must, in addition to the persons described in that section, be provided to the representative of the patient, where applicable, and must include, without limitation:

(a) The reason for the proposed discharge; and

(b) The date of the proposed discharge.

2. Except as otherwise provided in this subsection, written notice of the intent of a residential facility for groups to discharge a resident pursuant to NRS 449A.114 must be provided to a resident in a language that the resident or the representative of the resident, if applicable, is capable of reading. If the written notice is not provided in such a language, the facility must provide a translator who has been trained to assist the resident or the representative of the resident, if applicable, in the appeal process.

3. A residential facility for groups shall provide to a resident or a representative of the resident written notice of the location of the discharge of the resident not later than 10 days after providing written notice of the proposed intent to discharge the resident pursuant to NRS 449A.114.

(Added to NRS by 2023, 717)

NRS 449A.286 Assistance to and consultation with resident concerning discharge.

1. Before discharging a resident, a residential facility for groups shall offer assistance to the resident and any representative of the resident concerning the discharge and relocation of the resident. Such assistance must include, without limitation, information on available alternative placements.

2. Except in an emergency, a residential facility for groups shall involve a resident and his or her representative, if applicable, in planning the relocation of the resident and allow the resident or his or her representative to choose among the available alternative placements. Any emergency placement must be temporary and must terminate when the resident or his or her representative is able to offer input on the final decision concerning the placement of the resident. A residential facility for groups shall not require a resident to remain in a temporary or permanent placement.

3. In nonemergency situations, and where possible in an emergency, a residential facility for groups that transfers or discharges a resident shall, in consultation with the resident and his or her representative, if applicable, design and implement a transition plan in advance of the transfer or discharge.

4. A residential facility for groups is not in violation of this section or subject to disciplinary action if:

(a) A resident returns to the facility after an emergency transfer or discharge; and

(b) The emergency transfer or discharge was necessary to address health care needs of the resident which are outside the scope of care that the facility is legally authorized to provide.

(Added to NRS by 2023, 717)

DESIGNATION OF CAREGIVERS

NRS 449A.300 Definitions. As used in NRS 449A.300 to 449A.330, inclusive, unless the context otherwise requires, the words and terms defined in NRS 449A.303, 449A.306 and 449A.309 have the meanings ascribed to them in those sections.

(Added to NRS by 2015, 176)

NRS 449A.303 “Aftercare” defined. “Aftercare” means care or assistance that is provided to a patient after the patient is discharged following inpatient treatment at a hospital.

(Added to NRS by 2015, 176)

NRS 449A.306 “Caregiver” defined. “Caregiver” means a person designated as such pursuant to NRS 449A.312, including, without limitation, a relative, spouse, partner, foster parent, friend or neighbor.

(Added to NRS by 2015, 176)

NRS 449A.309 “Representative of the patient” defined. “Representative of the patient” means a legal guardian of the patient, a person designated by the patient to make decisions governing the withholding or withdrawal of life-sustaining treatment pursuant to NRS 449A.433 or a person given power of attorney to make decisions concerning health care for the patient pursuant to NRS 162A.700 to 162A.870, inclusive.

(Added to NRS by 2015, 176; A 2023, 492)

NRS 449A.312 Designation of caregiver for a patient, removal of designation and designation of new caregiver under certain circumstances; designation does not establish obligation to patient.

1. A caregiver may be designated for a patient by:

(a) The patient if he or she is 18 years of age or older and of sound mind;

(b) The representative of the patient if the patient is 18 years of age or older and incompetent; or

2. A patient described in subsection 1 may have a caregiver designated for him or her upon admission to a hospital as an inpatient in the manner described in NRS 449A.315.

3. If a caregiver is unable or unwilling to perform the duties of a caregiver, the designation of that person as a caregiver may be removed and a new caregiver may be designated by:

(a) The patient if he or she is 18 years of age or older and of sound mind;

(b) The representative of the patient if the patient is 18 years of age or older and incompetent; or

4. A caregiver is under no obligation to a patient solely because the patient, the representative of the patient or the parent or guardian of the patient has designated the caregiver pursuant to this section.

(Added to NRS by 2015, 176)

NRS 449A.315 Hospital to provide opportunity to designate caregiver for patient before discharge or when patient regains competence.

1. After admitting a patient as an inpatient and before discharging the patient, a hospital shall provide the opportunity to designate a caregiver for the patient to:

(a) The patient if he or she is 18 years of age or older and of sound mind;

(b) The representative of the patient if the patient is 18 years of age or older and incompetent; or

2. If a patient is unconscious or otherwise incompetent upon admission to a hospital as an inpatient and later regains competence while he or she is an inpatient at the hospital, the hospital shall, after the patient regains competence, provide the patient with the opportunity to designate a caregiver.

(Added to NRS by 2015, 176)

NRS 449A.318 Hospital to record designation or change of caregiver and request consent to release medical information to caregiver if required; hospital to record declination to designate caregiver.

1. If a patient, the representative of a patient or the parent or guardian of a patient designates a caregiver pursuant to NRS 449A.315 or changes a caregiver pursuant to NRS 449A.312, the hospital shall:

(a) Record the designation or change of the caregiver, the relationship of the caregiver to the patient and the name, telephone number and address of the caregiver in the medical record of the patient; and

(b) If required by the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, and any regulations adopted pursuant thereto or any other federal or state law, request the written consent of the patient, the representative of the patient or the parent or guardian of the patient, as applicable, to release medical information to the caregiver in a manner that complies with the applicable laws.

2. If a patient, the representative of a patient or the parent or guardian of a patient declines to designate a caregiver after being given the opportunity to do so pursuant to NRS 449A.315, the hospital shall record the declination in the medical record of the patient.

(Added to NRS by 2015, 177)

NRS 449A.321 Hospital to attempt to notify caregiver before planned discharge or transfer of patient. If a patient, the representative of a patient or the parent or guardian of a patient has provided consent for the hospital to release medical information to a caregiver pursuant to subsection 1 of NRS 449A.318, the hospital shall, before the patient is discharged or transferred to another facility, attempt to notify the caregiver of the planned discharge or transfer.

(Added to NRS by 2015, 177)

NRS 449A.324 Hospital to attempt to provide caregiver with discharge plan; contents of discharge plan; hospital to attempt to consult with caregiver regarding aftercare. If a patient, the representative of a patient or the parent or guardian of a patient has provided consent for a hospital to release medical information to a caregiver pursuant to subsection 1 of NRS 449A.318, the hospital shall, before the patient is discharged other than to a facility licensed pursuant to this chapter:

1. Attempt to provide the caregiver with a discharge plan. A discharge plan must include, without limitation:

(a) The name and contact information of the caregiver;

(b) A description of all necessary aftercare, including, without limitation, any requirements to maintain the ability of the patient to reside at home; and

(1) Any providers of health care, community resources or other providers of services necessary to carry out the discharge plan; and

(2) An employee of the hospital who will be available before the patient is discharged to answer questions concerning the discharge plan.

2. Attempt to consult with the caregiver, in person or using video technology, concerning the aftercare set forth in the discharge plan. Such consultation must include, without limitation:

(a) A demonstration of the aftercare set forth in the discharge plan, performed by an appropriate member of the hospital staff in a culturally and linguistically appropriate manner; and

(b) An opportunity for the caregiver to ask questions concerning the aftercare.

(Added to NRS by 2015, 177)

NRS 449A.327 Hospital to document certain actions and instructions in medical record of patient; hospital to proceed with planned discharge or transfer of patient if unable to reach caregiver.

1. A hospital shall document in the medical record of the patient:

(a) The attempt or completion of any actions required pursuant to NRS 449A.321 or 449A.324;

(b) Any instructions given pursuant to NRS 449A.324; and

2. If a hospital is unable to reach a caregiver after attempting to provide any information pursuant to NRS 449A.321 or 449A.324, the hospital must proceed with the discharge or transfer of the patient as scheduled.

(Added to NRS by 2015, 178)

NRS 449A.330 Hospital and employees and contractors of hospital not liable for aftercare provided improperly or not provided by caregiver. A hospital or an employee or contractor of a hospital that acts in compliance with NRS 449A.300 to 449A.330, inclusive, is not liable for any aftercare that is provided improperly or not provided by a caregiver.

(Added to NRS by 2015, 178)

WITHHOLDING OR WITHDRAWAL OF LIFE-SUSTAINING TREATMENT

NRS 449A.400 Short title; uniformity of application and construction.

1. NRS 449A.400 to 449A.481, inclusive, may be cited as the Uniform Act on Rights of the Terminally Ill.

2. NRS 449A.400 to 449A.481, inclusive, must be applied and construed to effectuate its general purpose to make uniform the law with respect to the subject of those sections among states enacting the Uniform Act on Rights of the Terminally Ill.

(Added to NRS by 1991, 629; A 2017, 1757)

NRS 449A.403 Definitions. As used in NRS 449A.400 to 449A.481, inclusive, unless the context otherwise requires, the words and terms defined in NRS 449A.406 to 449A.430, inclusive, have the meanings ascribed to them in those sections.

(Added to NRS by 1977, 759; A 1991, 632; 2017, 1757)

NRS 449A.406 “Advanced practice registered nurse” defined. “Advanced practice registered nurse” means a registered nurse who holds a valid license as an advanced practice registered nurse issued by the State Board of Nursing pursuant to NRS 632.237.

(Added to NRS by 2017, 1757)

NRS 449A.409 “Attending advanced practice registered nurse” defined. “Attending advanced practice registered nurse” means an advanced practice registered nurse who has primary responsibility for the treatment and care of the patient.

(Added to NRS by 2017, 1757)

NRS 449A.412 “Attending physician” defined. “Attending physician” means the physician who has primary responsibility for the treatment and care of the patient.

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

NRS 449A.415 “Declaration” defined. “Declaration” means a writing executed in accordance with the requirements of NRS 449A.433.

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

NRS 449A.418 “Life-sustaining treatment” defined. “Life-sustaining treatment” means a medical procedure or intervention that, when administered to a patient, serves only to prolong the process of dying.

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

NRS 449A.421 “Person” defined. “Person” includes a government or a governmental subdivision or agency.

(Added to NRS by 1991, 629)

NRS 449A.424 “Provider of health care” defined. “Provider of health care” means a person who is licensed, certified or otherwise authorized by the law of this state to administer health care in the ordinary course of business or practice of a profession.

(Added to NRS by 1991, 629)

NRS 449A.427 “Qualified patient” defined. “Qualified patient” means a patient 18 or more years of age who has executed a declaration and who has been determined by the attending physician or attending advanced practice registered nurse to be in a terminal condition.

(Added to NRS by 1991, 629; A 2017, 1757)

NRS 449A.430 “Terminal condition” defined. “Terminal condition” means an incurable and irreversible condition that, without the administration of life-sustaining treatment, will, in the opinion of the attending physician or attending advanced practice registered nurse, result in death within a relatively short time.

(Added to NRS by 1977, 759; A 1991, 633; 2017, 1757)

NRS 449A.433 Declaration relating to use of life-sustaining treatment.

1. A person of sound mind and 18 or more years of age may execute at any time a declaration governing the withholding or withdrawal of life-sustaining treatment. The declarant may designate another natural person of sound mind and 18 or more years of age to make decisions governing the withholding or withdrawal of life-sustaining treatment. The declaration must be signed by the declarant, or another at the declarant’s direction, and attested by two witnesses.

2. A physician or other provider of health care who is furnished a copy of the declaration shall make it a part of the declarant’s medical record and, if unwilling to comply with the declaration, promptly so advise the declarant and any person designated to act for the declarant.

3. A durable power of attorney for health care properly executed pursuant to NRS 162A.790 regarding the withholding or withdrawal of life-sustaining treatment constitutes for the purposes of NRS 449A.400 to 449A.481, inclusive, a properly executed declaration pursuant to this section.

(Added to NRS by 1977, 759; A 1985, 1747; 1991, 633; 2019, 2194)

NRS 449A.436 Form of declaration directing physician or advanced practice registered nurse to withhold or withdraw life-sustaining treatment. A declaration directing a physician or advanced practice registered nurse to withhold or withdraw life-sustaining treatment may, but need not, be in the following form:

DECLARATION

If you wish to include this statement in this declaration, you must INITIAL the statement in the box provided:

Withholding or withdrawal of artificial nutrition and hydration may result in death by starvation or dehydration. Initial this box if you want to receive or continue receiving artificial nutrition and hydration by way of the gastrointestinal tract after all other treatment is withheld pursuant to this declaration.

[............................................ ]

Signed this ........................ day of ................, ......

Signature .........................................................

Address ...........................................................

The declarant voluntarily signed this writing in my presence.

Witness ............................................................

Address ...........................................................

Witness ............................................................

Address ...........................................................

(Added to NRS by 1977, 760; A 1991, 633; 1993, 2790; 2017, 1757)

NRS 449A.439 Form of declaration designating another person to decide to withhold or withdraw life-sustaining treatment.

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

DECLARATION

If I should have an incurable and irreversible condition that, without the administration of life-sustaining treatment, will, in the opinion of my attending physician or attending advanced practice registered nurse, cause my death within a relatively short time, and I am no longer able to make decisions regarding my medical treatment, I appoint ............................... or, if he or she is not reasonably available or is unwilling to serve, .............................., to make decisions on my behalf regarding withholding or withdrawal of treatment that only prolongs the process of dying and is not necessary for my comfort or to alleviate pain, pursuant to NRS 449A.400 to 449A.481, inclusive. (If the person or persons I have so appointed are not reasonably available or are unwilling to serve, I direct my attending physician or attending advanced practice registered nurse, pursuant to those sections, to withhold or withdraw treatment that only prolongs the process of dying and is not necessary for my comfort or to alleviate pain.)

Strike language in parentheses if you do not desire it.