April 2008 Nevada Lawyer
SECRETARY OF STATE CREATES NEVADA’S FIRST ONLINE REGISTRY OF ADVANCE HEALTHCARE DIRECTIVES
The popularity of documents like living wills, various powers of attorney related to healthcare and advance directives reflects our desire to have a voice in what kind of care we receive while making critical and end-of-life healthcare decisions. It is an opportunity to tell healthcare professionals and family members what we want and do not want in terms of life-sustaining treatment. However, if those healthcare professionals and others do not have access to a living will or advance directive, they may not know the patient’s final wishes. Nevada’s newly-established Registry of Advance Directives, known as the “Living Will Lockbox,” will ensure that a living will or similar document is securely stored and easily accessible by healthcare providers when needed.
WHAT IS THE NEVADA ADVANCE DIRECTIVE REGISTRY (NADR)?
The Living Will Lockbox, located at Livingwilllockbox.com, is a secure, web-based database to which individuals can submit a living will or other advancedirective documents to be electronically stored. It is a virtual, electronic lock-box in which Nevadans can file certain directives, such as living wills, powers of attorney and “do not resuscitate” (DNR) orders, for access by designated healthcare professionals and family when medical treatment decisions must be made. The voluntary Living Will Lockbox, established by the 2007 Nevada State Legislature as the Registry of Advance Directives for Health Care, was developed by the office of Secretary of State Ross Miller, which also maintains the Living Will Lockbox. “The Secretary of State’s office manages the state’s corporate filing and the statewide voter registration database, so we have the experience to maintain this type of secure lock-box,” says Miller. “The Living Will Lockbox is about providing Nevadans with the assurance that their wishes regarding the course of their medical treatment will be protected.” The Living Will Lockbox provides peace of mind to patients facing end-of-life situations, as well as healthcare providers. Through the completely secure, confidential online system, doctors, hospitals, hospices and other healthcare providers can immediately access documents directing the exact wishes of a patient. The information contained in these advance directive documents can include limitations on treatment, type or level of care, and instructions regarding organ or tissue donation.
WHAT IS THE COST, AND HOW DO I REGISTER FOR NADR?
There is no cost to file a living will or associated documents with Livingwilllockbox.com. The Nevada Legislature provided initial funding for creation of the registry; the ongoing cost of maintaining and operating the registry will be supported by various grants and private-sector sponsors.
Filing your documents with livingwilllockbox.com is simple. The first step is to complete a living will or advance directive, often with the assistance of an attorney, healthcare professional or other trusted advisor. You may also get information from organizations such as the Nevada Center for Ethics and Health Policy or the local chapters of the AARP. Once the living will or advance directive is complete and ready to be filed, you can obtain a registration agreement from the Secretary of State’s offices in Carson City, Las Vegas or Reno, or online at livingwilllockbox.com or nvsos.gov. The registration agreement gives the registry permission to file the documents electronically. Then mail a copy of the living will or advance directive along with the signed, completed registration agreement to:
Living Will Lockbox
Nevada Secretary of State
101 N. Carson Street, Suite 3
Carson City, NV 89701-3714
After the office receives and scans the documents into the Living Will Lockbox, you will receive a letter confirming that the documents have been received and securely filed electronically with the Lockbox. You will also receive a registration ID number on a wallet-size card, adhesive labels with Living Will Lockbox contact information and instructions for accessing the registry, viewing the documents and making changes.
The Living Will Lockbox is an access-protected, secure electronic filing system and accessible only by authorized healthcare providers and people to whom you give your Lockbox access password. However, if you do not want to file your advance directives with the Lockbox, you can complete an Advance Directive Locator Form. The Advance Directive Locator Form is stored in lieu of the actual living will or advance directive and instead provides the physical location of these documents without providing the actual content. Using the Advance Directive Locator may, in some cases, delay important healthcare decisions until such time as the actual documents are located.
As the registrant, you may suspend, revoke, replace, edit, or delete all or part of your documents filed with the Lockbox. To make changes to the documents on file with the Lockbox, you must notify the Lockbox by submitting an Authorization to Change Form, indicating the changes you want to make. Mail or fax a newlyexecuted Advance Directive Form along with the Authorization to Change Form (available online or at the Secretary of State’s offices) to the Secretary of State.
It is important to remember, once you have registered with the Living Will Lockbox, to share your registration information. Share your wallet card registration number with your loved ones, attorney, and/or healthcare professionals. Be sure to let them know of any updates in your documents, ranging from a simple change of address to a new living will or advance directive. As the registrant you are responsible for ensuring that your ID number is shared only with people whom you want to be able to access your Lockbox file.
WHO ARE THE PROVIDERS THAT CAN ACCESS MY ADVANCE DIRECTIVE, AND WHAT ARE THEIR REPSONSIBILITIES?
Authorized providers are those individuals or organizations as defined in the Nevada Revised Statutes as healthcare providers and facilities that have been approved by the Secretary of State for access to the Lockbox. Authorized providers may access the Lockbox through their own access code or by using the registrant’s access code if the patient has provided it to them. Authorized providers have unlimited, secure access to the registry and can, therefore, immediately determine if a particular patient has a living will or another such document registered with the Living Will Lockbox. They can then access that patient’s advance directive.
In order to be an authorized provider, organizations or individuals must complete and submit a Provider Access Agreement and the Provider Access Application Form to the Secretary of State’s office. Once approved by the Secretary of State, the Lockbox will contact the provider with instructions and an account number. It is the responsibility of all authorized providers to protect the identification number issued to the provider, to limit access to the identification number to employees who have a need to access the Living Will Lockbox, to train employees on the proper use of the Lockbox and the registrant’s documents, and to inform the Lockbox as soon as possible of any pertinent changes to information provided in the authorized provider’s original application form. It is also the responsibility of all providers to create protocols to ensure that the Lockbox is checked when patients who are unable to communicate for any reason are admitted or provided services, to determine if the patient has a living will or an advance directive.
A SERVICE FOR ALL NEVADANS
Sadly, no matter what our age or current health, none of us know when we will need a living will or an advance directive of our own. This is why now is the the time to file your own living will or advance directive. Take the time to determine what specifics you want to address in your living will or advance directive. Consult with family and relevant professionals including attorneys, healthcare professionals and financial advisors. Then go to livingwilllockbox.com or to an office of the Secretary of State and complete and return the forms. Your registration in the Living Will Lockbox ensures that your last wishes are respected, and also gives your family and loved ones great relief by preventing them from having to make uninformed decisions regarding your final wishes.
T.E. Walsh is Public Information Officer for the Nevada Secretary of State’s office.