Tennessee Medical Power of Attorney Form [PDF]

Read our guide on appointing someone to make healthcare decisions on your behalf using Tennessee medical power of attorney.

Last update: 26 Mar 2024

Tennessee Medical Power of Attorney Form [PDF]

The Tennessee power of attorney, or healthcare power of attorney, is a legal document that one party, called the principal, uses to authorize another party, called the agent or attorney-in-fact, to make decisions about their healthcare on their behalf.

The healthcare power of attorney should be issued in the following situations:

When to Issue a Healthcare Power of Attorney

  • If the principal is of old age and wants to authorize someone to be able to make general decisions regarding their healthcare and treatment

  • If the principal is diagnosed with a terminal condition

  • If the principal is facing a possible surgery

  • If the principal wants to authorize someone to make end-of-life decisions on their behalf

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

Title 34, Chapter 6, Part 2 of the Tennessee Code regulates the status of medical power of attorney in Tennessee.

Section 34-6-203 provides that the principal must sign the Tennessee medical power of attorney before at least two witnesses or a notary public.

According to Section 34-6-207, the principal can revoke the medical power of attorney by notifying their doctor or agent about their intention to revoke, by creating the medical power of attorney revocation, or by creating a new medical power of attorney.

How to Write a Medical Power of Attorney in Tennessee

Here, you can see the step-by-step process of drafting a Tennessee medical power of attorney using our medical power of attorney template.

How to Write a Medical Power of Attorney

#1. Access the Medical Power of Attorney Form

On our website, you will find the medical power of an attorney template. You should fill it out with the help of our legal document builder. At the end of the process, the builder will create a printable and ready-to-sign medical power of attorney.

In the first section, you should enter the date of issuing the medical power of attorney, as well as the principal’s full name, mailing address, and contact details.

#2. Appoint a Healthcare Representative

Here, you should appoint a person you want to authorize to make decisions about your healthcare. The healthcare representative is also called the agent or the attorney-in-fact. The medical power of attorney form should include their full name, mailing address, and contact details.

The healthcare representative should be an adult with the legal capacity to act. The healthcare representative should also be someone you can trust. 

You can appoint your spouse, a relative, a friend, or another trusted individual. This is where you specify the rights and restrictions of a medical power of attorney and set the parameters for your agent's power.

#3. Identify an Alternative Healthcare Representative

The alternative healthcare representative is a person who can act in case the primary healthcare representative becomes unable to represent you. 

This can happen if the primary healthcare representative passes away, loses legal capacity, or is, in some other way, unable to represent you.

The alternative healthcare representative is also referred to as the secondary agent or secondary attorney-in-fact. The alternative healthcare representative should fulfill the same requirements as the primary one

You can appoint one or more people to act as alternative healthcare representatives.

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

After finalizing the medical power of attorney form, you should print and sign it before at least two adult witnesses. The state law provides that the witness cannot be the healthcare representative of the principal. 

It also provides that one of the witnesses cannot be:

  • A person related to the principal by marriage, blood, or adoption

  • A person entitled to any portion of the estate of the principal upon the death of the principal

#5. Notarize the Form

Instead of signing the document before witnesses, you can also sign it in front of a notary public. The notary public will confirm the principal's identity and acknowledge that they have signed the document.

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