Tennessee Advance Directive Form: How to Complete It Correctly

Most people assume creating a living will and appointing a medical power of attorney are two separate tasks. In Tennessee, they're not. The state's unified Advance Directive for Health Care combines both into a single document — and getting it wrong means your wishes may be ignored during a medical crisis.

Tennessee's form is governed by the Health Care Decisions Act (T.C.A. §§ 68-11-1801 et seq.) and was designed by the Board for Licensing Health Care Facilities. Unlike states that require separate living will and healthcare proxy documents, Tennessee consolidates everything: your treatment preferences, your healthcare agent appointment, and your quality-of-life instructions.

What the Tennessee Advance Directive Actually Covers

The unified form has three core sections that work together:

Part 1 — Appointment of Healthcare Agent. You name a primary agent and an alternate who can make medical decisions if you lose capacity. This replaces what other states call a "medical power of attorney" or "healthcare proxy."

Part 2 — Advance Care Plan (Living Will). You specify your treatment preferences for terminal conditions, persistent vegetative states, and other scenarios where recovery is unlikely. This is where you indicate whether you want life-sustaining treatments continued, withheld, or withdrawn.

Part 3 — Individual Instructions. You can add specific wishes about pain management, organ donation, comfort care preferences, and anything else not covered by the standard checkboxes. This section carries the same legal weight as the rest of the form.

Execution Requirements That Trip People Up

Under T.C.A. § 68-11-1803(b), your advance directive must be in writing and signed by you while you have decision-making capacity. You must be 18 or older (or an emancipated minor).

The signing must be witnessed by either a notary public OR two competent adult witnesses. Here's where most self-prepared directives fail:

• Neither witness can be your designated healthcare agent
• At least one witness must be unrelated to you by blood, marriage, or adoption
• At least one witness must have no claim to any portion of your estate under your will or by law
• The document must include a specific statutory attestation clause confirming witness eligibility

If you're in a nursing home or skilled nursing facility, you need an additional witness: an official patient advocate or state-designated ombudsman must verify you're acting voluntarily and with capacity.

The Critical Difference Between This Form and a POST

Your advance directive tells doctors what you want — but emergency responders (EMTs) in Tennessee cannot legally follow it. If paramedics arrive and you're in cardiac arrest, they must administer full life-support measures unless they see a valid Physician Orders for Scope of Treatment (POST) form or an out-of-hospital DNR order.

The POST form (governed by T.C.A. § 68-11-224) is a separate medical order signed by your physician that converts your treatment preferences into actionable clinical orders. If you have a serious illness or are nearing end of life, ask your doctor about completing a POST form alongside your advance directive.

How to Make Your Directive Legally Effective

1. Download the official form from the Tennessee Health Facilities Commission (tn.gov/hfc)
2. Fill out all sections that apply to your situation — leaving sections blank doesn't invalidate the form, but it limits your agent's guidance
3. Arrange your witnesses or notary and sign the document
4. Give copies to your healthcare agent, your alternate agent, your primary care physician, and any hospital where you regularly receive care
5. Consider registering it through the Department of Safety Driver's Services emergency contact portal

If your circumstances change — new diagnosis, new spouse, different preferences — you can revoke or update your directive at any time. Under Tennessee law, a newer directive automatically supersedes any earlier version.

What Happens Without One

If you lose decision-making capacity without an advance directive, Tennessee's default surrogate hierarchy kicks in under T.C.A. § 68-11-1806. Your supervising physician identifies a surrogate from this order: spouse (unless legally separated), adult child, parent, adult sibling, other adult relative, or any adult who has shown special care and concern for you.

The critical limitation: a default surrogate who was not chosen by you cannot decide to withhold or withdraw artificial nutrition and hydration — unless two physicians certify that continuing would merely prolong active dying for someone highly unlikely to regain capacity. Naming your own agent avoids this restriction entirely.

The Tennessee Advance Directive & Living Will Kit walks you through every section of the form, includes a witness verification protocol, and explains exactly how to coordinate your directive with a POST form and your estate plan.

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