Nev. Rev. Stat. § 454.060
1. The poison book shall be in form substantially as follows:
Name of Kind and Purpose Signature of Signature of
Date Purchaser Residence Quantity of Use Pharmacist Purchaser
[Part 1:207:1913; 1919 RL p. 2882; NCL § 5075]—(NRS A 1967, 1630)