Mississippi Advance Directive Form (Medical POA + Living Will)

A Mississippi advance directive is a document outlining a patient’s (the principal) future healthcare wishes during future treatment. This may also include a power of attorney, in which the principal assigns an agent who may take on the responsibility of making healthcare and treatment decisions should they be incapacitated.


Statutory Form§ 41-41-209

Signing Requirements (41-41-205(2.a)) – Two (2) witnesses, each of whom witnessed either the signing of the instrument by the principal or the principal’s acknowledgment of the signature or of the instrument.

State Definition (§ 41-41-203(b)) – “Advance health-care directive” means an individual instruction or a power of attorney for health care.

Spanish Version (Español) – Adobe PDF

Versions (4)

Mississippi Hospice and Palliative Care

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Mississippi State University 

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North Mississippi Health Services

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blankOCH Regional Medical Center

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