Mississippi Medical Power of Attorney Form [PDF]

A Mississippi medical power of attorney, or a healthcare power of attorney, is a legal document that one person, called the principal, uses to authorize another person, called the agent or the attorney-in-fact, to make important decisions about their healthcare.

A medical power of attorney form includes a list of life-sustaining treatments that the principal can select to receive or withhold if their health deteriorates to the point where they can’t make such decisions themselves.

The principal can also provide their preferences on whether they want to be subjected to artificial nutrition or hydration.

Laws and Legal Requirements for a Medical Power of Attorney in Mississippi

Laws and Legal Requirements

Title 41, Chapter 41 of the Mississippi Code, also called the Uniform Health-Care Decisions Act, regulates the status of medical power of attorney in Mississippi.

§ 41-41-205 provides that you must sign your medical POA before a notary public or at least two witnesses who will confirm that you signed the document willingly and that you are of sound mind at the time of signing.

§ 41-41-207 sets the revocation requirements. It provides that the principal can revoke the medical power of attorney by notifying their healthcare provider in person or in writing, by issuing a new power of attorney, or by issuing a power of attorney revocation.

How to Write a Medical Power of Attorney in Mississippi

In this section, you can find the step-by-step process of making the Mississippi medical power of attorney that is in accordance with all the state laws and regulations.

How to Write a Medical Power of Attorney

#1. Access the Medical Power of Attorney Form

Here, you will find the medical power of attorney template that you can access and fill out by following the instructions provided by our professionally designed document builder.

First, you should fill out the basic information, such as:

The principal's full name, mailing address, and contact details.
Date of issuing a medical power of attorney template.

#2. Appoint a Healthcare Representative

Here, you should appoint your agent or attorney-in-fact. You can do so by entering their full name, mailing address, and contact details in the medical power of attorney form.

The healthcare representative should be an adult with the legal capacity to act. Moreover, considering the importance of their authority, you should choose someone you can trust. That can be your spouse, a blood relative, a friend, or another trusted advisor.

In this section, you should also define your agent’s scope of authority by providing the medical power of attorney rights and limitations.

#3. Identify an Alternative Healthcare Representative

The alternative healthcare representative, or secondary agent, is a person who will act on behalf of the principal only if the primary agent loses legal capacity, passes away, or is, in some other way, unable to represent the principal.

The secondary agent should fulfill the same requirements as the primary agent. You can name one or more people to act as secondary agents. This will secure the principal in the sense that more people can act and make healthcare decisions on their behalf.

#4. Identify the Witnesses and Have Them Sign the Form

After finalizing your medical power of attorney form, you should print and sign it before two witnesses. The witnesses should be adults and have legal capacity.

They will confirm your identity and acknowledge that you are of sound mind and have willingly signed the document.

#5. Notarize the Form

Alternatively, you can sign the document in front of a notary public. Their acknowledgment will acknowledge the authenticity of your signature and the document itself and prevent potential fraud.