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Other Names: Mississippi Healthcare POA Mississippi Healthcare Power of Attorney Mississippi Medical POA Mississippi Healthcare Proxy
Mississippi Medical Power of Attorney document preview

What is a Mississippi Medical Power of Attorney?

A Mississippi Medical Power of Attorney is a legal document that grants a trusted person or entity permission to make health-related decisions on your behalf, such as refusing or accepting specific medical treatments, when you cannot do so. 
The person giving permission is known as the "principal," while the individual or organization gaining authority is known as the "agent." Suited for residents of Mississippi, our Power of Attorney for health care is made for use in Hinds County, Harrison County, DeSoto County, and in all other counties across the state. All Mississippi Medical PoA forms from Rocket Lawyer can be tailored to address your specific situation. With this essential document on hand, your agent will be able to provide confirmation to healthcare providers and other parties that they can legally act in your interest.

When to use a Mississippi Medical Power of Attorney:

  • You're struggling with health concerns and want to make sure the right person can make decisions for you.
  • You'd just like to be prepared for any situation.

Sample Mississippi Medical Power of Attorney

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You have the right to give instructions about your own health care. You also have the right to name someone else to make health-care decisions for you. This form lets you do either or both of these things. It also lets you express your wishes regarding the designation of your primary physician. If you use this form, you may complete or modify all of any part of it. You are free to use a different form.


This form is a power of attorney for health care. It lets you name another individual as agent to make health-care decisions for you if you become incapable of making your own decisions or if you want someone else to make those decisions for you now even though you are still capable. You may name an alternate agent to act for you if your first choice is not willing, able or reasonably available to make decisions for you. Unless related to you, your agent may not be an owner, operator, or employee of a residential long-term health-care institution at which you are receiving care.


Unless the form you sign limits the authority of your agent, your agent may make all health-care decisions for you. This form has a place for you to limit the authority of your agent. You need not limit the authority of your agent if you wish to rely on your agent for all health-care decisions that may have to be made. If you choose not to limit the authority of your agent, your agent will have the right to:


(a) Consent or refuse consent to any care, treatment, service, or procedure to maintain, diagnose, or otherwise affect a physical or mental condition;


(b) Select or discharge health-care providers and institutions;


(c) Approve or disapprove diagnostic tests, surgical procedures, programs of medication, and orders not to resuscitate; and


(d) Direct the provision, withholding, or withdrawal of artificial nutrition and hydration and all other forms of health care.


After completing this form, sign and date the form at the end and have the form witnessed by one of the two alternative methods listed below. Give a copy of the signed and completed form to your physician, to any other health-care institution at which you are receiving care, and to any health-care agents you have named. You should talk to the person you have named as agent to make sure that he or she understands your wishes and is willing to take the responsibility.


You have the right to revoke this advance health-care directive or replace this form at any time.






I designate the following individual as my agent to make health-care decisions for me:

Agent's Name:




Phone: Home: Work:



If I revoke the authority of my agent and first alternate agent or if neither is willing, able, or reasonably available to make a health-care decision for me, I designate as my second alternate agent:


Second Alternate Agent's Name:




Phone: Home: Work:









My agent's authority becomes effective when my primary physician determines that I am unable to make my own health-care decisions unless I mark the following box. If I mark this box my agent's authority to make health-care decisions for me takes effect immediately.





My agent shall make health-care decisions for me in accordance with this power of attorney for health care, any instructions I give in this form, and my other wishes to the extent known to my agent. To the extent my wishes are unknown, my agent shall make health-care decisions for me in accordance with what my agent determines to be in my best interest. In determining my best interest, my agent shall consider my personal values to the extent known to my agent.





If a guardian of my person needs to be appointed for me by a court, I nominate the agent designated in this form. If that agent is not willing, able, or reasonably available to act as guardian, I nominate the alternate agents whom I have named in the order designated.


If the physician I have designated above is not willing, able, or reasonably available to act as my primary physician, I designate the following physician as my primary physician:







EFFECT OF COPY: A copy of this form has the same effect as the original.





________________________________________ __________________

[name] [date]









(This document must either be (a) signed by two (2) qualified adult witnesses who are personally known to you and who are present when you sign or acknowledge your signature OR (b) acknowledged before a notary public in the state.)





Name: ________________________________

Address: ________________________________






Name: ________________________________

Address: ________________________________



two witnesses who then sign the document in your presence and in each other's presence.a notary who then notarizes the document.

Mississippi Medical Power of Attorney FAQs

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  • How do I get Medical Power of Attorney in Mississippi?

    It is very simple to grant or receive the authority you may need with a free Mississippi Medical Power of Attorney template from Rocket Lawyer:

    1. Make your document - Provide a few basic details and we will do the rest
    2. Send or share it - Review it with your agent or ask a legal question
    3. Sign it - Optional or not, witnesses/notarization are a best practice

    This route, in most cases, would be notably less expensive than meeting and hiring your average lawyer. If necessary, you may fill out this Medical PoA on behalf of your spouse or another relative, and then help them sign it after you've drafted it. Keep in mind that for this document to be accepted as valid, the principal must be mentally competent at the time of signing. In the event that the principal is already unable to make their own decisions, a conservatorship could be required. When facing such a scenario, it would be important for you to speak with a lawyer .

  • Who should have a Power of Attorney for healthcare in Mississippi?

    Anyone who is over 18 should have a Medical Power of Attorney. Although it's unpleasant to acknowledge, a time will likely come when you are not able to make your own medical decisions. Here are some typical circumstances in which you might consider PoA forms to be helpful:

    • You are getting older or dealing with ongoing health issues
    • You have plans to live in a community care facility
    • You will be expecting to undergo a medical procedure requiring anesthesia
    • You have been diagnosed with a terminal condition

    Regardless of whether your Mississippi Medical Power of Attorney is being produced as a result of an unexpected emergency or as part of a long-term plan, notarization and witnesses can often help to protect your agent if anyone questions their privileges and authority.

  • Is there a difference between a Mississippi Healthcare Proxy and a Mississippi Medical Power of Attorney?

    At times, in researching the topics of estate planning or elder care, you or a loved one might see the terms "healthcare power of attorney", "medical power of attorney" and "healthcare proxy" used together. In actuality, they're one and the same. That said, it's entirely possible to have agency over affairs that aren't health-related, in which case, "proxy" typically is not the preferred term.

  • Do I need to work with a lawyer for my Mississippi Medical PoA?

    Mississippi Medical PoA forms are generally straightforward, but you or your agent could need legal advice. The answer will depend on whom you contact, but quite often some lawyers will not even accept requests to review your document if they were not the author. A more favorable approach would be to request help from the Rocket Lawyer On Call® attorney network. When you sign up for a Premium membership, you have the ability to ask for guidance from an Rocket Lawyer network attorney with relevant experience or ask additional questions about your Medical Power of Attorney. Rocket Lawyer is here to help.

  • How much would I normally have to pay for an attorney to help me get a Power of Attorney form for health care in Mississippi?

    The cost of finding and working with a lawyer to draft a Medical Power of Attorney might add up to anywhere between two hundred and five hundred dollars, based on your location. Unlike the other websites that you may stumble upon, Rocket Lawyer offers much more than a Power of Attorney template. If you ever require assistance from a lawyer, your Rocket Lawyer membership offers up to a 40% discount when you hire an attorney from our Rocket Lawyer attorney network.

  • Will I have to take additional actions after drafting a Mississippi Medical Power of Attorney?

    With a Premium membership, you can make edits, save it in PDF format or as a Word document, and print it. In order to make the drafted PoA into a truly legal document, you must sign it. Make sure to provide a copy of the fully signed document to your agent(s) and care providers.

  • Does a Medical Power of Attorney need to be notarized, witnessed, and/or recorded in Mississippi?

    The guidelines for PoA forms are different by state; however, in Mississippi, your Power of Attorney will require the signatures of two witnesses or a notary public. At least one of the witnesses to your PoA form should not be a relative, spouse, adopted child, heir, or any other beneficiary. As a basic principle, witnesses must be 18 years old or older, and no witness should also be your PoA agent.

    See Mississippi Medical/Healthcare Power of Attorney law: Title 41, Ch. 41

Mississippi Medical Power of Attorney document preview

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