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Tennessee health care legal form
Download the August 2026 Tennessee Statutory Living Will packet, the Tenn. Code Ann. § 32-11-105 statutory form, with election checkboxes for nourishment and fluids and organ donation. Get the form in editable Word and true fillable PDF. Add the completed sample PDF if you want a filled-in reference.
A state-specific statutory living will packet, reviewed against the current Tennessee statute and ready for instant secure access.
The packet reproduces Tennessee’s statutory living-will form with both election groups: artificially provided nourishment and fluids, and organ or tissue donation.
Section 32-11-104(a) permits acknowledgment before a notary or signing before two witnesses. The statutory attestation and jurat are built into the form.
Download and complete the files on your own device, then print and execute the form. Your personal details are never entered into an online form builder.
This download includes 1 document in editable Word and fillable PDF formats. Use the Word version for editing; the fillable PDF can be completed on screen, then printed and signed.
Review the complete statutory form text below before purchasing. Your licensed download (editable Word and fillable PDF) is delivered after checkout.
STATUTORY LIVING WILL FORM
STATE OF TENNESSEE
I, ______________________________________, willfully and voluntarily make known my desire that my dying shall not be artificially prolonged under the circumstances set forth 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 medical 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implemented for the purpose of sustaining life, or the life process, I direct that medical care be withheld or withdrawn, and that I be permitted to die naturally with only the administration of medications or the performance of any medical procedure deemed necessary to provide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 care or to alleviate pain.
ARTIFICIALLY PROVIDED NOURISHMENT AND FLUIDS:
By checking the appropriate line below, I specifically:
Authorize the withholding or withdrawal of artificially provided 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 CERTIFICATION:
Notwithstanding my previous declaration relative to the withholding or withdrawal of life-prolonging procedures, if as indicated below I have expressed my desire to donate my organs and/or tissues 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 maintain 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 specifically:
Desire to donate my organs and/or tissues for transplantation.
Desire to donate my ___________________________________________.
(Insert specific organs and/or tissues 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 that 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 used herein shall be as set forth in the Tennessee Right to Natural Death Act, Tennessee Code Annotated, § 32-11-103.
I understand the full import of this declaration, and I am emotionally and mentally competent to make this declaration.
In acknowledgment whereof, I do hereinafter affix my signature on this the ______ day of ___________________, 20____.
_______________________________
Signature of Declarant
We, 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 action 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 of 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 employee of the attending physician or a health facility in which the declarant is a patient; and that we are not persons who, at the present time, have a claim against any portion of the estate of the declarant upon the declarant's death.
_______________________________
Witness #1’s Printed Name
_______________________________
Witness #1’s Signature
_______________________________
Witness #2’s Printed Name
_______________________________
Witness #2’s Signature
STATE OF TENNESSEE
COUNTY OF __________________
Subscribed, sworn to and acknowledged before me by _________________________, the declarant, and subscribed and sworn to before me by _________________________ and _________________________, witnesses, this ______ day of ____________, 20____.
_______________________________________
Notary Public
My Commission Expires: ___________________
Legal currency, verified
This Tennessee living will records your instructions about life-prolonging medical care if you have a terminal condition and cannot direct your own care. It reproduces the statutory declaration in Tenn. Code Ann. § 32-11-105.
The form follows § 32-11-105 and includes the statutory declaration, treatment directions, election groups, witness attestations, and notary jurat.
Choose one line in each election group: whether artificially provided food, water, nourishment, or fluids may be withheld or withdrawn, and whether you want to donate organs or tissues.
Under § 32-11-104(a), you may acknowledge your signature before a notary public without witnesses, or sign before two witnesses without notarization. The statutory template includes both witness and notary blocks.
You may revoke the declaration as provided in § 32-11-106. Give a copy to your attending physician; under § 32-11-104(b), the physician must make it part of your medical record.
Your purchase includes an editable Word file and a true fillable PDF you can complete on screen before printing and signing. For naming someone to make medical decisions when you cannot, see the Tennessee Durable Power of Attorney for Health Care.
This form is not legal advice and does not replace advice from a Tennessee attorney about your circumstances.
ILRG is committed to top quality legal forms that are valid in all states. If you are not 100 percent satisfied after purchase, contact us for a full refund.
Yes. It reproduces the statutory form in Tenn. Code Ann. § 32-11-105, verified in August 2026 with no changes enacted by the 2025 to 2026 General Assembly.
Either route suffices under § 32-11-104(a): acknowledge your signature before a notary without witnesses, or sign before two witnesses without notarization. The statutory form includes both blocks, and many people complete both.
A witness must be a competent adult. At least one witness must not be related to you by blood, marriage, or adoption and must not be entitled to your estate. The statutory declaration also has the witnesses state that they are not your attending physician or the physician’s or health facility’s employee and have no claim against your estate.
One election addresses artificially provided nourishment and fluids. The other addresses organ or tissue donation. Check one line in each group.
A living will states your wishes for care during a terminal condition. The Tennessee Durable Power of Attorney for Health Care appoints an agent to make medical decisions when you cannot.
Both contain the same statutory text. Word is editable. The true fillable PDF lets you type into data blanks and select election checkboxes on screen. Print the completed form and execute it before a notary or two witnesses.