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Free Tennessee Medical Power of Attorney Form

A Tennessee medical power of attorney names your health care agent inside the state's Advance Directive for Health Care. Our guided form follows the state layout and its two signing options.

  • Download as PDF and Word
  • E-sign included

How It Works

1

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2

Fill In Your Details

Answer a few simple questions to customize your form.

3

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Download or print your custom document in PDF or Word.

What Is a Medical Power of Attorney in Tennessee?

Tennessee combines the appointment of a health care agent and your treatment wishes in one Advance Directive for Health Care. The Tennessee Health Facilities Commission publishes the state form under the Tennessee Health Care Decisions Act, Tenn. Code § 68-11-1801 and following.

Tennessee Signing Rules

The state form lays out two ways to make your directive valid.

Block A: Two Witnesses

You can sign your Tennessee medical power of attorney in front of two witnesses. The person you name as agent cannot be one of them.

One Witness Must Be Independent

At least one of your two witnesses cannot be related to you or be your beneficiary.

Block B: A Notary Instead

You may choose to have a notary public witness your signature instead of the two witnesses.

What Does a Tennessee Notary Confirm?

The notary confirms that you are personally known or proved by satisfactory evidence. The notary also confirms that you signed or acknowledged the document in person.

The notary then declares under penalty of perjury that you appear to be of sound mind and under no duress, fraud, or undue influence. That makes the notary route a strong choice if finding two qualified witnesses is hard. Either route is valid for a Tennessee medical power of attorney.

Note Your Treatment Limits

Tennessee’s forms include space to describe situations where you would not want CPR, a feeding tube, dialysis, or a breathing machine. Discuss those choices with your agent and doctors so they understand them.

How to Sign Your Tennessee Medical Power of Attorney

Use these steps to finish your Tennessee medical power of attorney form:

  1. Name your health care agent and an alternate.
  2. Record your wishes about treatments such as CPR and feeding tubes.
  3. Choose Block A with two witnesses or Block B with a notary.
  4. If using witnesses, make sure one is unrelated and not a beneficiary.
  5. Sign in front of the witnesses or notary.
  6. Give copies to your physicians and agent, and keep a copy in your files.

What to Include in Your Tennessee Form

The Tennessee state form covers both parts of your planning in one document:

  • Your health care agent and alternate
  • Your treatment wishes and quality-of-life choices
  • Any specific instructions about CPR, feeding tubes, dialysis, or breathing machines
  • The signature block for witnesses or a notary

The state form’s instructions also tell you to give copies to your doctors and keep one in your own files. Telling family members what the document says can prevent disagreements later, especially if relatives expect to be consulted.

Review your choices after any major change in your health, and sign a new form if your wishes or your agent change.