Tennessee Advance Directive Form (Medical POA & Living Will)

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The Tennessee Advance Directive provides a legally enforceable arrangement for an individual to denote their preferences for future health treatment. The form is a common measure to put in place as a precaution should an unforeseen event occur, rendering one to enter an incapacitated state. Also recorded in the agreement is a section to nominate an attorney-in-fact to be issued as an authority to make health care decisions for the principal party. Consideration for an individual’s wishes can be indicated concerning the following possible quality of life conditions or treatments:

  • CPR
  • Tube-Feeding
  • Dialysis
  • Life-Support
  • Comatose Condition
  • End-of-Life Care
  • Hospice Care
  • Organ Donation

Finalizing the contract will require all endorsements to be performed in the presence of a notary public of two (2) witnessed approved by the Tennessee Code Annotated § 68-11-1803(b) that states each witness cannot be:

“related to the principal by blood, marriage, or adoption and would not be entitled to any portion of the estate of the principal upon the death of the principal under any will or codicil made by the principal existing at the time of execution of the advance directive or by operation of law then existing.”

Other Versions (5)

AARP (Caring Connections) Version

Download: Adobe PDF
Instructions: Adobe PDF

 

 


Five Wishes (Aging with Dignity) Version 

Download: Adobe PDF
Information: Adobe PDF

 

 


Prepare for Your Care Version (also available in Spanish/en Español)

Download: Adobe PDF

 

 

 


Spanish Version

Download: Adobe PDF

 

 

 


Vanderbilt University Medical Center Version (also available in Spanish/en Español)

Download: Adobe PDF

 

 

 

Additional Resources

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Durable (Financial) Power of Attorney

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POST (Physician Orders for Scope of Treatment) Form (also available in Spanish/en Español)
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Provider Identification of Surrogate (also available in Spanish/en Español)
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