Healthcare Durable Power Of Attorney Form printable pdf download

Tennessee Healthcare Durable Power of Attorney

WARNING TO PERSON EXECUTING THIS DOCUMENT

This is an important legal document.

Before executing this document, you should know these important facts:

• This document gives the person you designate as your agent (the attorney-in-fact) the power to make

healthcare decisions for you. Your agent must act consistently with your desires as stated in this

document.

• Except as you otherwise specify in this document, this document gives your agent the power to consent

to your doctor not giving treatment or stopping treatment necessary to keep you alive.

• Notwithstanding this document, you have the right to make medical and other healthcare decisions for

yourself so long as you can give informed consent with respect to the particular decision. In addition, no

treatment may be given to you over your objections, and healthcare necessary to keep you alive may not

be stopped or withheld if you object at the time.

• This document gives your agent authority to consent, to refuse to consent, or to withdraw consent to any

care, treatment, service or procedure to maintain, diagnose, or treat a physical or mental condition. This

power is subject to any limitations that you include in this document. You may state in this document

any types of treatment that you do not desire. In addition, a court can take away the power of your agent

to make healthcare decisions for you if your agent: (1) authorizes anything that is illegal, (2) act contrary

to your desires as stated in this document.

• You have the right to revoke the authority of your agent by notifying your agent or your treating

physician, hospital, or other healthcare provider orally or in writing of the revocation.

• Your agent has the right to examine your medical records and to consent to their disclosure unless you

limit this right in this document.

• Unless you otherwise specify in this document, this document gives your agent the power after you die

to: (1) authorize an autopsy; (2) donate your body or parts thereof for transplant or therapeutic or

educational or scientific purposes; and (3) direct the disposition of your remains.

• If there is anything in this document that you do not understand, you should ask an attorney to explain it

to you.

I, ___________________________________, of _________________________________________________

Name

Address

Tennessee, have read the warning section and I appoint ____________________________________________

As my healthcare agent or attorney-in-fact.

This person can be reached at the following address and phone number: _______________________________

_________________________________________________________________________________________

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Healthcare Durable Power Of Attorney Form