Durable Power Of Attorney For Health Care - Legal Aid Society Of Middle Tennessee

Download a blank fillable Durable Power Of Attorney For Health Care - Legal Aid Society Of Middle Tennessee in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Durable Power Of Attorney For Health Care - Legal Aid Society Of Middle Tennessee with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

- Warning to person executing this document -
This is an important legal document. Before executing
that you include in this document. You may state in this
this document you should know these important facts:
document any types of treatment that you do not desire. In
addition, a court can take away the power of your agent to
This document gives the person you designate as your
make health care decisions for you if your agent: (1) authorizes
agent (your attorney in fact) the power to make health care
anything that is illegal; or (2) acts contrary to your desires as
decisions for you. Your agent must act consistently with your
stated in this document.
desires as stated in this document.
You have the right to revoke the authority of your agent
Except as you otherwise specify in this document, this
by notifying your agent or your treating physician, hospital
document gives your agent the power to consent to your doctor
or other health care provider orally or in writing of the
not giving treatment or stopping treatment necessary to keep
revocation.
you alive.
Your agent has the right to examine your medical
Notwithstanding this document, you have the right to
records and to consent to their disclosure unless you limit this
make medical and other health care decisions for yourself so
right in this document.
long as you can give informed consent with respect to the
particular decision. In addition, no treatment may be given to
Unless you otherwise specify in this document, this
you over your objection, and health care necessary to keep you
document gives your agent the power after you die to: (1)
alive may not be stopped or withheld if you object at the time.
authorize an autopsy; (2) donate your body or parts thereof
for transplant or therapeutic or educational or scientific
This document gives your agent authority to consent, to
purposes; and (3) direct the disposition of your remains.
refuse to consent, or to withdraw consent to any care, treatment,
service, or procedure to maintain, diagnose or treat a physical
If there is anything in this document that you do not
or mental condition. This power is subject to any limitations
understand, you should ask an attorney to explain it to you.
[Tennessee Code Annotated, § 34-6-205; Durable Power Of Attorney For Health Care]
DURABLE POWER OF ATTORNEY FOR HEALTH CARE
By signing this document, I appoint the
that I need to keep me comfortable and
person I name on page 2 to make health care
relieve pain.
decisions for me if I am ever unable to make
them for myself. I intend for this person to
In the situation described here,
ensure that my living will is honored and
I authorize
do not authorize
that decisions about my medical care respect
this person to approve a treatment or
my wishes as far as they are known. I intend
medicine to keep me comfortable and out of
for this person to have the broadest discretion
pain, even if it may cause permanent physical
and power allowed by law to approve, refuse
damage or addiction or hasten my death.
or stop medical care for me.
If I cannot take food and/or liquids by
If I should ever reach the point at which
mouth in the situation described here,
my doctor believes I am going to die no
I authorize
do not authorize
matter what is done, I direct this person to
this person to refuse or stop artificial feeding,
ensure that I am allowed to die naturally.
such as giving me nourishment or fluids
That means not starting or continuing to use
through a tube or a vein.
machines or treatments that would only
prolong my dying.
At that point, this person should ensure
that I have only the medicine or treatment
8/98 - Legal Aid Society of Middle Tennessee
Durable Power Of Attorney For Health Care - page 1 of 2

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go
Page of 2