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Legal Tennessee Medical Power of Attorney Template

A Tennessee Medical Power of Attorney form allows an individual to designate another person to make healthcare decisions on their behalf if they are unable to do so. This legal document assures that one's health care preferences are respected, even when they cannot communicate them directly. Setting up a Medical Power of Attorney is a proactive measure to maintain control over one's medical care.

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Delving into the realm of healthcare decisions, especially during times of uncertainty or incapacity, requires a foundation of trust and foresight, which is where the Tennessee Medical Power of Attorney form plays a pivotal role. This crucial legal document allows individuals to appoint someone they trust explicitly to make healthcare decisions on their behalf, should they find themselves unable to do so. Not only does it cover decisions about medical treatment and interventions, but it also extends to end-of-life care preferences, thereby ensuring that one's healthcare wishes are respected and followed. For residents of Tennessee, understanding the nuances of this form, including its legal requirements, scope of authority granted to the appointed agent, and the specific conditions under which it becomes active, is invaluable. By empowering a chosen representative with the authority to make healthcare decisions, this document bridges the gap between personal healthcare preferences and the reality of unforeseen medical situations, providing peace of mind to all involved.

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Tennessee Medical Power of Attorney

This Tennessee Medical Power of Attorney is a legal document that grants a chosen individual the authority to make healthcare decisions on behalf of the signer in case they become unable to do so. This document is in compliance with the Tennessee Uniform Health Care Decisions Act, ensuring its acceptability and legitimacy within the state of Tennessee.

Principal Information:

Full Name: ___________________________
Address: _____________________________
City: _____________, State: Tennessee
Zip Code: ___________
Phone Number: ________________________
Date of Birth: ________________________

Agent Information:

Full Name of Agent: ___________________________
Relationship to Principal: _____________________
Address: _____________________________
City: _____________, State: ___________
Zip Code: ___________
Alternate Phone Number: ___________________

Alternate Agent Information (Optional):

In the event the primary agent is unable or unwilling to serve, an alternate agent may act with the same authority.

Full Name of Alternate Agent: ___________________________
Relationship to Principal: _____________________
Address: _____________________________
City: _____________, State: ___________
Zip Code: ___________
Alternate Phone Number: ___________________

Powers Granted:

This document grants the named agent the authority to make a wide range of healthcare decisions on behalf of the principal. These decisions can include, but are not limited to, consenting or refusing medical treatment, accessing medical records, and deciding on the principal's residence for health care purposes.

Limitations:

If there are any specific limitations to the powers granted to the agent, state them here:

_________________________________________________________
_________________________________________________________

Signatures:

This document must be signed by the principal, the designated agent, and at least one witness or a notary public to be legally binding.

Principal's Signature: _____________________ Date: _________
Agent's Signature: _________________________ Date: _________
Alternate Agent's Signature (If any): ______________ Date: _________
Witness/Notary Public Signature: _____________ Date: _________

This Tennessee Medical Power of Attorney becomes effective immediately upon the incapacity of the principal, as determined by a licensed physician, and remains in effect until the principal is once again capable of making their own healthcare decisions or upon the principal's revocation of the document.

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Form Attributes

Fact	Description
Definition	A Tennessee Medical Power of Attorney form allows an individual to appoint someone else to make healthcare decisions on their behalf if they become unable to do so.
Governing Laws	This form is governed by the Tennessee Uniform Health Care Decisions Act, found in sections 68-11-1801 through 68-11-1813 of the Tennessee Code.
Eligibility to be an Agent	The person chosen as an agent must be a competent adult. However, healthcare providers directly involved in the patient's care, and operators or employees of healthcare facilities where the patient is receiving care, cannot be appointed.
Scope of Authority	An agent's authority can include decisions related to healthcare providers, medical treatments, and end-of-life care, based on what the principal specifies in the document.
Requirements for Validity	The form must be signed by the principal and witnessed by two adults or notarized. Witnesses cannot be the person who is appointed as an agent, related to the principal by blood, marriage, or adoption, or directly financially responsible for the principal’s medical care.
Revocation	The principal can revoke the document at any time, as long as they are competent. This can be done through a written revocation, by destroying the document, or by clearly expressing the intent to revoke it in any manner.
Activation	The Medical Power of Attorney only becomes active when the principal is determined to be unable to make their own healthcare decisions, as certified by their physician.
Durability	This document remains effective even if the principal becomes incapacitated, until it is revoked.

Instructions on Utilizing Tennessee Medical Power of Attorney

Filling out a Tennessee Medical Power of Attorney form is a significant step in ensuring your health care preferences are followed in the event that you're unable to communicate your decisions yourself. This legal document allows you to appoint someone you trust to make health care decisions on your behalf. The process of completing the form is straightforward, but it’s important to take the necessary time to consider your choices and discuss them with the person you intend to appoint as your health care agent. Below you will find simple steps to help you fill out the form accurately.

Gather all required information, including your full legal name, address, and the full legal name and address of your chosen health care agent.
Start by entering your name and date of birth at the top of the form to affirm that the document is being executed willingly and that you understand its purpose.
Appoint your health care agent by including their name, address, and contact information in the designated section. Ensure this person is willing and able to act on your behalf.
Specify any limitations on your health care agent's authority. Clearly outline what decisions they are allowed and not allowed to make regarding your health care, if any.
Include instructions for your health care under certain conditions, if desired. This section is optional but can provide clear guidance on your health care preferences.
Designate an alternate agent, if you wish. This is recommended in case your primary agent is unable or unwilling to make decisions when required.
Review all sections of the form to verify that the information is accurate and reflects your wishes. Make any necessary adjustments.
Sign and date the form in the presence of a notary public. Tennessee requires that your Medical Power of Attorney be notarized to be legally binding.
Have the notary public complete their section, affixing their seal to authenticate the document.
Distribute copies of the completed and notarized document to your health care agent, alternate agent (if applicable), close family members, and your primary care doctor. Keep the original in a safe but accessible place.

Once these steps are completed, your Tennessee Medical Power of Attorney will be in effect, empowering your chosen agent to make health care decisions in line with your values and desires when you are not able to do so yourself. Remember, this document can be revoked or amended at any time should your wishes or circumstances change. Regularly reviewing and updating it ensures that it always reflects your current preferences.

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