Tennessee Living Will Template
This Living Will is created in accordance with the laws of the State of Tennessee. It allows you to express your wishes regarding medical treatment in case you become unable to communicate your preferences.
Instructions: Fill in the blanks with your information and review it carefully. Consider discussing your wishes with family and healthcare providers.
Personal Information:
- Name: ____________________________________
- Date of Birth: ____________________________
- Address: __________________________________
- City: __________________ State: __________ Zip: __________
Declaration:
I, the undersigned, hereby declare that if I am diagnosed with a terminal condition or if I am in a persistent vegetative state, and I am unable to make my own health care decisions, I direct that my health care providers provide the following:
- Do not resuscitate (DNR) in the event my heart stops or I stop breathing.
- Do not provide life-sustaining treatment.
- Provide comfort care and treatment to alleviate my suffering.
If I am unable to make decisions and facing a serious medical situation, this Living Will reflects my choices concerning the extent of medical treatment I wish to receive.
Additional Wishes:
Include any specific instructions regarding medications, procedures, or other treatments:
____________________________________________________________________
____________________________________________________________________
Signatures:
By signing below, I confirm that this Living Will reflects my wishes:
Signature: __________________________ Date: _______________
If required, witness signatures:
Witness 1: _________________________ Date: _______________
Witness 2: _________________________ Date: _______________
This Living Will is made in accordance with the Tennessee Code Annotated § 32-11-101 et seq.
Review this document regularly, especially after any significant changes in your health or personal circumstances.