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Tennessee Advance Directive for Health Care Form

Appoints a medical decision maker and records care preferences; the appointment includes a choice about when the agent’s authority begins.

Jurisdiction
Tennessee
Purpose
Medical & health care
Source / form version
Form VMR 2822, revised February 2019; still linked from the publisher’s advance-directives page.
Resource format
PDF
Signing
Sign and date with either two competent adult witnesses or a notary. Neither witness may be the agent or alternate, and at least one must be unrelated and not entitled to the estate.
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Sources checked: 2026-11-13. General information, not individual legal advice.

Name someone and choose the timing

Vanderbilt’s Tennessee directive provides an agent and an alternate, then asks when the appointment should operate. Read the immediate-authority option and the option tied to lack of capacity rather than assuming every directive has the same start date. Talk with the proposed agent about how to communicate with your doctors and family.

Sources: [1] [3] [4]

Connect treatment wishes to the stated conditions

The second page asks about conditions you would or would not be willing to live with. The following treatment choices apply to the unacceptable conditions you identified when they are irreversible. These pages address resuscitation, artificial support, treatment of new conditions, and tube feeding or IV fluids. Discuss the medical meaning of these choices with a clinician before treating a checkbox as a complete care plan.

Sources: [1] [3] [4]

Finish and share the complete directive

Use the additional-instructions area for relevant wishes and consider the separate organ-donation selection. Complete the final-page signature section with two eligible witnesses or a notary, following the declarations printed there. Keep all four pages together, give copies to the agent and care team, and replace outdated copies when your decisions or contact information change.

Sources: [1] [3] [4]

Common questions

Must I use Vanderbilt’s patient portal to get the form?

No. The direct PDF is publicly downloadable. Sending a signed copy to a provider is a separate step from downloading the blank document.

Sources: [1] [3] [4]

Does this authorize my agent to pay all my bills?

No. This is a health care directive. A financial POA is the separate document to consider for banking, property, and other financial matters.

Sources: [1] [3] [4]

Related forms and guides

Sources and verification

  1. Vanderbilt University Medical Center: source and instructions (opens in a new tab)
  2. Direct PDF (opens in a new tab)
  3. Tennessee Health Facilities Commission — advance directives (opens in a new tab)
  4. Tennessee Code §68-11-1803 (opens in a new tab)

HTTP 200; four pages and 41 fields. All four rendered pages inspected, including VMR 2822 (02/2019) footer, linked conditional treatment choices, and witnesses-or-notary option. Government PDF was inaccessible; current health-system page supplied this actual form.

The date above records a source check. It does not certify that a form is suitable for your circumstances or that an attorney has reviewed your document. Read the publisher’s current instructions before use.