$13.95

Add to cart

Tennessee mmission Expires: __________________________ 3 ___________________ and _____________________________________, witnesses, this ______ day of ____________, 20____. _________________________________________________________________ Notary Public My CoSSEE ) ) ) COUNTY OF _____________________ ) Subscribed, sworn to and acknowledged before me by _________________________________, the declarant, and subscribed and sworn to before me by _____________declarant upon the declarant's death. _________________________________________________________________ Witness _________________________________________________________________ Witness STATE OF TENNEee of the attending physician or a health facility in which the declarant is a patient; and that we are not persons who, at the 2 present time, have a claim against any portion of the estate of the f the estate of the declarant upon the declarant's decease under any will or codicil thereto presently existing or by operation of law then existing; that we are not the attending physician, an employction taken herein and its possible consequence. We, the undersigned witnesses, further declare that we are not related to the declarant by blood or marriage; that we are not entitled to any portion oWe, the subscribing witnesses hereto, are personally acquainted with and subscribe our names hereto at the request of the declarant, an adult, whom we believe to be of sound mind, fully aware of the acknowledgment whereof, I do hereinafter affix my signature on this the ___________ day of ____________, 20_____ _________________________________________________________________ Declarant's Signature ___________________________________________________________________________ I understand the full import of this declaration, and I am emotionally and mentally competent to make this declaration. In a____________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ _sed herein shall be as set forth in the Tennessee Right to Natural Death Act, Tennessee Code Annotated, § 32-11-103. ADDITIONAL INSTRUCTIONS (optional ­ or cross out): ________________________________at this declaration shall be honored by my family and physician as the final expression of my legal right to refuse medical care and accept the consequences of such refusal. The definitions of terms ues for transplantation) ____________ DO NOT desire to donate my organs or tissues for transplantation. In the absence of my ability to give directions regarding my medical care, it is my intention thly: ____________ Desire to donate my organs and/or tissues for transplantation. 1 ____________ Desire to donate my _____________________________________________. (Insert specific organs and/or tissuintain me on artificial support systems only for the period of time required to maintain the viability of and to remove such organs and/or tissues. By checking the appropriate line below, I specificales for transplantation, or any of them as specifically designated herein, I do direct my attending physician, if I have been determined dead according to Tennessee Code Annotated, § 68-3-501(b), to maATION: Notwithstanding my previous declaration relative to the withholding or withdrawal of lifeprolonging procedures, if as indicated below I have expressed my desire to donate my organs and/or tissuovided food, water or other nourishment or fluids. ____________ DO NOT authorize the withholding or withdrawal of artificially provided food, water or other nourishment or fluids. ORGAN DONOR CERTIFICcare or to alleviate pain. ARTIFICIALLY PROVIDED NOURISHMENT AND FLUIDS: By checking the appropriate line below, I specifically: ____________ Authorize the withholding or withdrawal of artificially prwithheld or withdrawn, and that I be permitted to die naturally with only the administration of medications or the performance of any medical procedure deemed necessary to provide me with comfortable l probability, will result in my death, regardless of the use or discontinuance of medical treatment implemented for the purpose of sustaining life, or the life process, I direct that medical care be below, and do hereby declare: If at any time I should have a terminal condition and my attending physician has determined there is no reasonable medical expectation of recovery and which, as a medicaCLARATION I, _______________________________________________________, willfully and voluntarily make known my desire that my dying shall not be artificially prolonged under the circumstances set forthing out of this document should be discussed with a tax professional. [_] The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com Living Will DElting an attorney first to make sure it fits your particular situation. Advice from a local attorney is always recommended when dealing with estate planning matters. Any possible tax consequences arisre not a substitute for legal and/or tax advice. Laws vary from time to time and from state to state. These forms should only be a starting point for you and should not be used or signed without consu and no implied or express warranties have been made or are provided as to their suitability for any specific purpose or as to their legal effect or completeness. [_]These forms are not intended and a or revocation made by the declarant to the attending physician. Such revocation shall be made a part of the declarant's medical record by the attending physician. [_] These forms are provided "as is"vely communicated by the declarant to the attending physician or other concerned health care provider: (1) Written revocation by the declarant, dated and signed by the declarant. (2) By oral statement 32-11-106. Revocation of declaration. A declaration may be revoked at any time by the declarant, without regard to the declarant's mental state or competency, by any of the following methods, effectiThe declaration may be substantially in the following form, but not to the exclusion of other written and clear expressions of intent to accept, refuse, or withdraw medical care. (form included below) Page 3 concerned health care provider. An attending physician who is so notified shall make the declaration, or a copy of it, part of the declarant's medical record. 32-11-105. Form of declaration. e responsibility of the declarant or someone acting on the declarant's behalf to deliver a copy of such living will or declaration to the attending physician and/or other Information & Instructions ­ declarant is a patient, and neither of them has a claim against any portion of the estate of the declarant. The declaration shall be substantially in the form established in § 32-11-105. (b) It is the by the declarant. In addition, the witnesses shall verify that neither of them is the attending physician nor an employee of the attending physician nor an employee of a health facility in which thee not related to the declarant by blood or marriage, and that they would not be entitled to any portion of the estate of the declarant upon the declarant's demise under any will or codicil thereto madn, to become effective on loss of competency, which declaration shall be acknowledged and signed by the declarant in the presence of two (2) witnesses who shall verify in such declaration that they arval from artificial support systems. 32-11-104. Execution of declaration. (a) Any competent adult person may execute a declaration directing the withholding or withdrawal of medical care to such perso the purpose of sustaining life, or the life processes; and (10) "Tissue donation" means a procedure to recover tissue following a declaration of death pursuant to § 68-3-501(b)(1), and following remoasonable medical expectation of recovery and which, as a medical probability, will result in the death of such human being, regardless of the use or discontinuance of medical treatment implemented for (9) "Terminal condition" means any disease, illness, injury or condition, including, but not limited to, a coma or persistent vegetative state, sustained by any human being, from which there is no re pain-killing drugs, nonartificial oral feeding, suction, hydration and hygienic care; (8) "Physician" means any person licensed or permitted to practice medical care under title 63, chapters 6 and 9; (7) "Palliative care" includes any measure taken by a physician or health care provider designed primarily to maintain the patient's comfort. These also include, but are not limited to, sedatives andt or fluids"; (6) "Organ donation" means a procedure to recover vascular organs following a declaration of death pursuant to § 68-3-501(b)(2), but prior to removal from artificial support systems; andl or durable power of attorney for health care include the following or substantially the following: "I authorize the withholding or withdrawal of artificially provided food, water or other nourishmennterpreted to allow the withholding or withdrawal of simple nourishment or fluids so as to condone death by starvation or dehydration unless the provisions of the instrument which creates a living wilardless of the method used; radiation therapy; or any other medical act designed for diagnosis, assessment or treatment or to sustain, restore or supplant vital body function. This part shall not be iransfusions; mechanical ventilation; dialysis; Information & Instructions ­ Page 2 cardiopulmonary resuscitation; artificial or forced feeding of nourishment, hydration or other basic nutrients, reg any procedure or treatment rendered by a physician or health care provider designed to diagnose, assess or treat a disease, illness or injury. These include, but are not limited to: surgery; drugs; tnt to this chapter, stating declarant's desires for medical care or non-care, including palliative care, and other related matters such as organ donation and body disposal; (5) "Medical care" includeser," "health care facility" or "health facility" means a person, facility or institution licensed or authorized to provide health or medical care; (4) "Living will" means a written declaration, pursuate the nature and consequences of a decision to accept or refuse treatment; (2) "Declarant" means an individual who declares a living will under the provisions of this chapter; (3) "Health care providovided. 32-11-103. Definitions. The following definitions shall govern the construction and operation of this chapter: (1) "Competent person" means an individual who is able to understand and appreciao express their desire to donate their organs and/or tissues. (b) The general assembly does further empower the exercise of this right by written declaration, called a "living will," as hereinafter prs and treatment. The general assembly further declares that it is in the public interest to facilitate recovery of organs and/or tissues for transplantation and to provide mechanisms for individuals t accept, refuse, withdraw from, or otherwise control decisions relating to the rendering of the person's own medical care, specifically including palliative care and the use of extraordinary procedure) The general assembly declares it to be the law of the state of Tennessee that every person has the fundamental and inherent right to die naturally with as much dignity as circumstances permit and tonnessee Statutes Title 32 Chapter 11 Section 102 et. Seq. For your convenience, we have included useful excerpts from the Tennessee Statutes relating to Living Wills. 32-11-102. Legislative intent. (aInformation and Instructions Tennessee Living Will This package contains (1) Information and Instruction for Tennessee Living Will; (2) Tennessee Living Will. This Tennessee Living Will is based on Te Tennessee