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Mississippi Medical Durable Power of Attorney Form |
The Mississippi Medical Durable Power Of Attorney form legally permits the principal to nominate another person who is often called the `Agent`, to make their medical welfare decisions for them if they should become incapacitated through illness and unable to do so themselves. This document requires attestation by two (2) witnesses or a notary public in accordance with ยง 41-41-209.
How to Write
Power Of Attorney For Health Care
The principal and the agent must enter their details.
- Principal`s name.
- Principal`s address.
- Principal`s telephone number.
- Agent`s name.
- Agent`s address.
- Agent`s telephone number.
When Death Is Imminent
A) The principal must enter details of medical treatments which must be withheld or withdrawn when death is imminent.
When Terminally Ill
B) The principal must enter details of medical treatments which must be withheld or withdrawn when they are deemed to be terminally Ill.
Other Special Conditions
C) The principal must enter details of any other special conditions or requirements with respect to their end of life care.
Pregnancy
D) Acknowledgement by the principal that if they are found to be pregnant they understand the Power Of Attorney Document becomes invalid.
- Principal`s signature.
Successor Agents
Enter the details of Successor agents in case the appointed agent becomes unavailable.
- Successor agents name.
- Successor agents address.
- Successor agents telephone number.
Declaration
The principal must enter their details to show they understand the purpose of this document.
- Principals signature.
- Date.
Signatures
The details of the witnesses or notary must be entered.
- Witnesses signature.
- Witnesses address.
- Re-enter witnesses signature.
- County.
- Date.
- Name of notary.
- Signature of notary.
