Tennessee Advance Directive Form

In the state of Tennessee, medical practitioners may utilize an advance directive to guide their treatment if a patient becomes incompetent or incapacitated. With an advance directive, you have the option of choosing an agent, obtaining medical treatment, donating organs, and providing instructions for your loved ones after you die. After it has been signed by two witnesses or a notary public, the form may be utilized in the event of a person's incapacity.

Tennessee advance directive template

Tennessee Advance Directive Form

Laws and statutes to adhere to

The Statute of Limitations is found in Chapter 11 of Title 68, Section 18 of Chapter 11. (Tennessee Health Care Directions Act)

Requirements needed to complete the signing process- According to Section 68-11-1803(b), two (2) witnesses or notary public are required to sign the document.

State Definition (§ 68-11-1802(a)(1))- The term "advance directive" refers to a personal instruction or written declaration for the provision of health care for the individual in the future, according to state legislation (68-11-1802(a)(1)). Documents such as a living will or durable power of attorney for health care fall in this category.

How and what to put into writing


(1) The main identity of the declarant. It is necessary to document your full name as the Tennessee Principal before you can begin the process of awarding your Medical Attorney-in-Fact the right to make medical treatment decisions on your behalf.

Part 1: The Principal Agent

(2) The name of the Health Care Agent for the state of Tennessee- If you have chosen a political party to meet with Tennessee doctors about your medical care, be certain that they are aware of the meeting, understand the commitment, and are up to speed on your medical treatment choices. Reviewers should be able to read the full name of your Tennessee Medical Attorney-in-Fact or Health Care Agent in this document.

(3) Relationships between agents and principals in Tennessee's healthcare system- Describe your working relationship with the Medical Attorney in Fact, who is responsible for carrying out directives.

(4) The contact information for the Tennessee Medical Attorney-in-Fact.

(5) Number to call if you need to speak with a Tennessee Medical Attorney in Fact. The phone numbers for the Tennessee Attorney-in-Fact’s, home, and mobile phones should all be supplied.

Substitute for agent

(6) Alternate Agent true Identity (Tennessee). Designating someone who is accessible and permitted to exercise the primary control over your care that this agreement provides in the case that the primary agent is unavailable can be beneficial. Fill in for your Alternate Agent in Tennessee, or your Alternate Medical Attorney in Fact, if you live in another state.

(7) Relationship with alternate agent.

(8) Please provide the address of the alternative agent.

(9) Contact Information of the attorney-in-fact.

When Does It Become Effective?

(10) Tennessee's healthcare agents have access to a wide range of authority. In the event that you are incompetent or unconscious while seeking treatment, the Tennessee Attorney-in-Fact may be authorized to represent you in health care or treatment choices, communicate with clinicians on your behalf, and convey your orders to others. Select the first checkbox statement to grant your Tennessee Medical Attorney-in-Fact immediate access to your health care decisions, or the second checkbox statement to document that these powers are only granted if you have a terminal illness and are unable to communicate treatment instructions to Tennessee doctors.

Part 2: Describe your desires for a better quality of life.

(11) Someone becomes unconscious and remains unconscious for the rest of his or her life. When it comes to health care professionals and your Medical Attorney in Fact, you have the right to voice your choices as a patient in the state of Tennessee. Look through a list of these qualifications and check the yes/no boxes to see whether you qualify. A checkmark in the "Yes" box indicates that one of the medical conditions listed below is acceptable for the applicant. If this is something you find objectionable, please choose "No." You should choose the "Yes" option if you are prepared to live in a state of "Permanent Unconscious Condition." If you do not want your life to be artificially prolonged while you are in this state, do not choose "No." Alternatively, select "Yes." When you are diagnosed as chronically unconscious, it is critical to understand that no therapy will be able to assist you in regaining awareness.

(12) Continuous Perplexity- Patients suffering from neurodegenerative diseases or severe brain injuries may have difficulty seeing their environment and the people in them. As a consequence, you may find yourself unable to do routine everyday duties or recognize people who are close to you, among other things (i.e., parents, siblings, spouses). Choose the "Yes" checkbox if you are able to live with these circumstances; otherwise, select the "No" checkbox if the quality of life is less than what you are able to withstand in this situation.

(13) When it comes to many aspects of daily life, one must depend on others for aid. Depending on your health, you may find yourself fully reliant on others to do even the most basic of daily tasks. To maintain your personal cleanliness, clothes, and nourishment, you will need to be well looked after at all times. Those who are unsure whether or not they will be able to bear living in these kinds of conditions have the option of selecting "Yes" or "No."

(14) End-stage illness. It is possible that the termination of an illness may be a dramatic and painful procedure that will take a significant amount of time. If you do not believe that these conditions will have an impact on your quality of life, check the "Yes" checkbox. You have the option of choosing "No" after being diagnosed with a terminal condition if you do not want your quality of life to deteriorate further, or if you would rather die naturally rather than via medical intervention.

Your Expected Outcomes from Your Treatment

(15) Cardiopulmonary resuscitation (CPR)- Is a life-saving technique (Cardiopulmonary Resuscitation). Any of the quality of life issues that you have indicated as "no" may encourage Tennessee Physicians to carry out interventions or treatments in order to extend your life if you have them. This kind of treatment or intervention is available for you to take advantage of (making them intolerable). When you check the "Yes" or "No" boxes on the form, you are informing Tennessee Responders and Health Care Providers whether or not you want CPR done if you are in one of these conditions and are suffering from cardiac arrest.

(16) Artificial Support/Life Support. If you desire to be put on life support or have your life medically maintained at any point in the future, choose "Yes" from the drop-down menu. Alternatively, if you only want your life to be prolonged under the situations indicated by a "Yes" in the preceding table, choose "No."

(17) Treatment of a previously unidentified illness. While dealing with one of the problems described in the preceding table, it is possible that you could develop a new medical condition or suffer an injury. If you need medical assistance for any of these issues, regardless of whether you are suffering from one of the traumatic diseases listed above, choose "Yes" in the "Do you require medical attention?" field. If you don't wish to participate, you may choose the "No" option on the registration form.

(18) Tube feeding and intravenous fluids Providers of healthcare in Tennessee are taught to keep an eye on a patient's nutrition and hydration as closely as possible and to intervene if required. By selecting "Yes," you are agreeing that your nutrition and hydration levels will be maintained, even if this means that they must be done artificially. You should tick the "No" box if you are experiencing one of the quality of life difficulties you described as being undesirable. You should also indicate that you do not want to be put on a feeding tube.

Further Directives Part 4.

(19) A guide to the Declarant Treatment Program in Tennessee. Any restrictions you wish to impose on your Medical Attorney-in-capacity Factor's ability to make medical decisions on your behalf must be included in this document, as must your expectations or instructions for treatment, as well as any post-death preferences or directives that you wish to be followed. Consider how you can make the most of the available area. More space may be produced by adding more lines of material or by continuing the content on a second page that is physically linked to the present page (by the time you sign it).

Organ Donation

(20) Anatomical Gifts Volunteers are needed. As a Tennessee organ donor, you have the right to make use of this directive to guarantee that your intentions are followed to the letter. Please select the box to let us know what you're interested in giving so that we can better serve you. You have the option of selecting "Any Organ/Tissue," "Your Entire Body," or "Select Organs/Tissues" from the drop-down menu.

(21) The inability to acknowledge the importance of organ donation is a serious problem. An option for "No Organ/Tissue Donation" may be found on the Tennessee Organ Donation Registry's website.


(22) Patient from the state of Tennessee. A Medical Attorney-in-Fact must be designated and authorized to make healthcare decisions on your behalf in Tennessee. You must sign your name to do so. This work should be completed in the presence of two witnesses or a Notary Public who has a valid license.

(23) The document has the date of signing by a patient from Tennessee. The most current date should be sufficient to tell Tennessee Health Care Providers and everyone else who sees this order provided you signed your name and issued the order properly.

A Witness Is Blocked

(24) Witness No. 1's signature is included in this document. Although a Notary Public is not necessary, two witnesses will be required to witness your signature in order to authenticate it. When witness number one has finished reading each of Block A's allegations, they should sign their name in the space given.

(24) Witness No. 2's signature is included in this document.  For Block B to be valid, the second Witness in attendance must sign his or her name to attest that the claims in Block B are correct. In order to do this, he or she may use a Witness 2 line.

Notary Public 

(26) Notarization- is the process of getting one's signature notarized. Unless you have two witnesses, the Notary Public who is witnessing your signature as the Tennessee Patient (Principal or Declarant) must notarize the document and your signature if you are signing as the Tennessee Patient (Principal or Declarant). Block B will be used as formal documentation of the Notary Public's work when it has been completed.

Download our free Tennessee advance directive in an instant to create a legally binding document.

Download our free Tennessee advance directive in an instant to create a legally binding document.

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