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This document contains the following sections:
- Part I: Power of Attorney for Health Care
- Part II: Instructions for Health Care (Living Will)
- Part III: Designation of Primary Physician (Optional)
Laws
Statutes – Mississippi Uniform Health-Care Decisions Act (§ 41-41-201 – § 41-41-229)
Definition – “Advance health-care directive” means an individual instruction or a power of attorney for health care (§ 41-41-203(b)).
Statutory Form – § 41-41-209
Signing Requirements – Acknowledgment of Two (2) Witnesses and/or a Notary Public (§ 41-41-205(2))
Revocation – § 41-41-207
Other Versions (9)
- AARP
- Five Wishes (Aging with Dignity)
- Forrest Health
- Mississippi State University
- North Mississippi Medical Center
- OCH Regional Medical Center
- Prepare for Your Care
- Spanish/Español
- University of Mississippi Medical Center
Download: Adobe PDF
Instructions: Adobe PDF
Five Wishes (Aging with Dignity) Version
Download: Adobe PDF
Information: Adobe PDF
Download: Adobe PDF
Mississippi State University Version
Download: Adobe PDF
North Mississippi Medical Center Version
Download: Adobe PDF
Download: Adobe PDF
Download: Adobe PDF
Download: Adobe PDF
University of Mississippi Medical Center (UMMC) Version
Download: Adobe PDF
Additional Resources
- Forrest Health – PSDA and Advance Directive Information
- Mississippi State University – Advance Directive Guide
- North Mississippi Medical Center – Conversations Before the Crisis Workbook
Related Forms
Advance Directive Wallet Cards
Download: Adobe PDF
Durable (Financial) Power of Attorney
Download: Adobe PDF, MS Word (.docx)
Physician Orders for Sustaining Treatment (POST) Form
Download: Adobe PDF
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