DIRECTIVE TO PHYSICIANS AS PROVIDED BY NEVADA REVISED STATUTES,
SECTION 449.610 


                     DIRECTIVE TO PHYSICIANS 

Date __________________ 


I, _______________, being of sound mind, intentionally and
voluntarily declare: 

1. If at any time I should have an incurable injury, disease, or
illness certified to be a terminal condition by two physicians,
and where the application of life-sustaining procedures would
serve only to artificially prolong the moment of my death and
where my physician determines that my death is imminent whether or
not life-sustaining procedures are utilized, I direct that such
procedures be withheld or withdrawn, and that I be permitted to
die naturally, 

2. It is my intention that this directive shall be honored  by my
family and attending physician as the final expression of my legal
right to refuse medical or surgical treatment and accept the
consequences from such refusal. 

3. If I have been diagnosed as pregnant and that fact is known to
my physician, this directive shall have no force or effect during
the course of my pregnancy. I understand the full import of this
directive and I am emotionally and mentally competent to execute
it. 



Signed _________________________________________________ 


STATE OF _______))) 
COUNTY OF __________)))    

Dated: _________________________ 


 Then and there personally appeared the within named 

________________________________ and __________________________ ,
who, being duly sworn, depose and say: That they witnessed the
execution of the within Directive to Physicians of the within
named _______________, that said declarant subscribed said
Directive to Physicians and declared the same to be his Directive
to Physicians in their presence, that they thereafter subscribed
the same as witnesses in the presence of said declarant and in the
presence of each other and at the request of said Declarant; that
the said Declarant at the time of the execution of said Directive
to Physicians appeared to them to be of full age and of sound mind
                           
and memory, and that they make this affidavit at the request of
said declarant. 





________________________________________ 
Witness 





________________________________________   
Witness 




Subscribed to and sworn to before me 
this ________ day of _________, 19_____. 





_____________________________________________ 
Notary Public