MISSISSIPPI DURABLE POWER OF ATTORNEY FOR HEALTH CARE

(A.K.A. Health-Care Directive & HIPAA Authorization)

[// GUIDANCE: This template is designed to comply with the Mississippi Uniform Health-Care Decisions Act, Miss. Code Ann. § 41-41-201 et seq., and relevant HIPAA regulations, 45 C.F.R. Parts 160 & 164. Confirm current statutory citations before finalizing.]

TABLE OF CONTENTS

I. Document Header
II. Definitions
III. Operative Provisions
    A. Appointment of Health-Care Agent
    B. Scope of Authority
    C. End-of-Life Instructions
    D. HIPAA Authorization
    E. Organ & Tissue Donation
IV. Representations & Warranties
V. Covenants & Restrictions
VI. Default & Remedies
VII. Risk Allocation
VIII. Dispute Resolution
IX. General Provisions
X. Execution Block

I. DOCUMENT HEADER

1. Document Title
   This instrument shall be known as the “Mississippi Durable Power of Attorney for Health Care” (the “Directive”).

2. Parties
   a. Principal: [PRINCIPAL LEGAL NAME], a resident of [COUNTY], Mississippi, date of birth [DOB], (“Principal”).
   b. Agent: [AGENT LEGAL NAME], a resident of [COUNTY/STATE], (“Agent”).
   c. Alternate Agent(s) (optional):
   i. First Alternate: [ALT AGENT 1 NAME]
   ii. Second Alternate: [ALT AGENT 2 NAME]

3. Effective Date
   This Directive is effective on the date executed by the Principal below (the “Effective Date”) and shall remain in effect until revoked pursuant to Section IX.

4. Governing Law & Jurisdiction
   This Directive shall be governed by and construed in accordance with the laws of the State of Mississippi applicable to health-care directives.

II. DEFINITIONS

For purposes of this Directive, the following capitalized terms have the meanings set forth below. Terms defined herein apply equally to singular and plural forms.

“Act” means the Mississippi Uniform Health-Care Decisions Act, Miss. Code Ann. § 41-41-201 et seq.

“Agent” means the individual designated in Section III.A to make Health-Care Decisions on behalf of the Principal.

“Artificially Administered Nutrition and Hydration” means the medical provision of food or fluids through intravenous, gastric, or nasogastric means.

“End-of-Life Decision” means a decision to withhold, withdraw, or continue life-sustaining treatment when the Principal is terminally ill, permanently unconscious, or otherwise lacks capacity, as determined under the Act.

“Good Faith” has the meaning set forth in Miss. Code Ann. § 41-41-207(2): honesty in fact in the conduct, transaction, or representation concerned.

“Health-Care Decision” includes consent, refusal of consent, or withdrawal of consent to any care, treatment, service, or procedure.

“HIPAA” means the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations, 45 C.F.R. Parts 160 & 164.

“Incapacitated” means lacking the ability to understand and appreciate the nature and consequences of a health-care decision, as certified in writing by a licensed physician or other qualified clinician.

“Principal” means the individual executing this Directive.

III. OPERATIVE PROVISIONS

A. Appointment of Health-Care Agent

1. Primary Appointment
   The Principal hereby appoints the Agent to make all Health-Care Decisions for the Principal if the Principal is Incapacitated.

2. Alternate Appointment(s)
   If the Agent is unable, unwilling, or unavailable to act, authority passes in the order listed in Section I.2.c.

[// GUIDANCE: If no alternates are desired, delete Section III.A.2.]

B. Scope of Authority

1. General Authority
   Subject to Sections III.C–III.E, the Agent may make any Health-Care Decision the Principal could make if capable, including but not limited to:
   a. Selection or discharge of health-care providers and institutions;
   b. Approval or refusal of diagnostic tests, medications, surgeries, and other treatments;
   c. Placement in or release from care facilities;
   d. Access to and disclosure of medical records;
   e. Signing required consents, releases, and waivers.

2. Limitations
   a. The Agent shall act only in Good Faith and in accordance with the Principal’s known wishes or, if unknown, in the Principal’s Best Interest.
   b. The Agent may not consent to commitment to a mental health institution for more than [X] days without court approval.
   c. The Agent may not override limitations expressly stated in this Directive.

3. Durable Nature
   The authority conferred herein shall not be affected by the Principal’s subsequent incapacity.

C. End-of-Life Instructions

1. Life-Sustaining Treatment
   [SELECT ONE OR MORE OPTIONS – strike through inapplicable]
   a. ☐ I direct my Agent to WITHHOLD or WITHDRAW life-sustaining treatment if I am terminally ill or permanently unconscious.
   b. ☐ I direct that life-sustaining treatment CONTINUE unless it offers no reasonable hope of recovery.
   c. ☐ I leave End-of-Life Decisions entirely to my Agent’s discretion.

2. Artificially Administered Nutrition & Hydration
   ☐ WITHHOLD/☐ WITHDRAW  ☐ CONTINUE  ☐ AGENT DISCRETION

3. Pain Management
   The Agent is authorized to approve medication to relieve pain or discomfort even if such medication may inadvertently hasten death.

4. Do-Not-Resuscitate (DNR) Orders
   The Agent may execute DNR orders consistent with these instructions.

[// GUIDANCE: Customize selections to reflect client’s wishes. Consider attaching a statutory living will as Schedule 1 if more detail is needed.]

D. HIPAA Authorization

1. Disclosure Authorization
   The Principal authorizes all covered entities under HIPAA to disclose to the Agent any protected health information (“PHI”) of the Principal.

2. Purpose
   The Agent may use PHI solely to make informed Health-Care Decisions and to act under this Directive.

3. Duration
   This HIPAA Authorization is effective upon execution and shall survive the Principal’s death to the extent PHI is required to carry out post-death decisions (e.g., organ donation).

E. Organ & Tissue Donation

1. Donation Preference
   [SELECT] ☐ I WISH / ☐ I DO NOT WISH to donate organs or tissues for transplantation, therapy, research, or education.

2. Agent Authority
   Unless prohibited above, the Agent is authorized to consent to anatomical gifts under Miss. Code Ann. § 41-39-35.

IV. REPRESENTATIONS & WARRANTIES

1. Principal Capacity
   The Principal represents that he/she/they is at least 18 years old, of sound mind, and not acting under duress or undue influence.

2. Agent Acceptance
   By signing in Section X, the Agent represents and warrants that he/she/they:
   a. Is at least 18 years old and of sound mind;
   b. Accepts the appointment and duties herein;
   c. Will act in Good Faith and consistent with the Principal’s instructions.

3. Reliance
   Third parties may rely on the Agent’s representations and actions without further inquiry into the validity of this Directive or the scope of the Agent’s authority.

V. COVENANTS & RESTRICTIONS

1. Agent Duties
   a. Duty of Good Faith and Loyalty to the Principal’s expressed wishes.
   b. Duty to consult with health-care providers and to consider medical advice.
   c. Duty to keep reasonably informed any person designated by the Principal as an “Interested Person” in Schedule 2.

2. Record-Keeping
   The Agent shall maintain contemporaneous records of significant Health-Care Decisions for at least [X] years.

3. Conflicts of Interest
   The Agent shall avoid transactions that create a material conflict of interest with the Principal unless expressly authorized.

VI. DEFAULT & REMEDIES

1. Events of Default
   The following constitute defaults under this Directive:
   a. Agent acts outside the scope of Section III.B;
   b. Agent fails to act in Good Faith;
   c. Agent becomes legally incapacitated or otherwise disqualified.

2. Removal & Replacement
   Upon default, an Interested Person or health-care provider may petition the chancery court exercising probate jurisdiction to remove the Agent and appoint the next Alternate Agent or a guardian ad litem.

3. Emergency Injunctive Relief
   Any Interested Person may seek injunctive relief in the appropriate Mississippi chancery court to enforce or restrain acts under this Directive.

4. Attorneys’ Fees
   The court may award reasonable attorneys’ fees and costs to the prevailing party in any action to enforce this Directive.

VII. RISK ALLOCATION

1. Indemnification
   The Principal shall indemnify and hold harmless any Agent acting in Good Faith and within the authority granted hereunder from any liability, claim, or expense arising out of such action or inaction.

2. Liability Cap
   No Agent shall be liable for monetary damages except for losses resulting from gross negligence, willful misconduct, or actions taken outside the scope of authority.

3. Insurance
   [OPTIONAL] The Principal or estate may maintain liability insurance for the benefit of the Agent.

4. Force Majeure
   Neither the Agent nor any health-care provider shall be liable for failure to comply with this Directive to the extent compliance is impossible due to war, natural disaster, or comparable exigent circumstance.

VIII. DISPUTE RESOLUTION

1. Governing Law
   This Directive is governed by the laws of the State of Mississippi, without regard to conflicts-of-law principles.

2. Forum Selection
   Exclusive venue for any action arising under or relating to this Directive shall lie in the chancery court of the county where (a) the Principal resides or (b) the Principal is receiving care, as provided under Mississippi probate jurisdiction (“state_probate_court”).

3. Arbitration & Jury Waiver
   Arbitration is not available under this Directive, and no party waives the right to trial by jury.

4. Injunctive Relief
   The right to seek injunctive or other equitable relief in connection with Health-Care Decisions is expressly preserved.

IX. GENERAL PROVISIONS

1. Revocation & Amendment
   a. The Principal may revoke or amend this Directive in whole or in part at any time by:
   i. A signed, dated writing;
   ii. Physical cancellation or destruction of the original Directive; or
   iii. An oral statement in the presence of two adult witnesses.
   b. Any amendment or revocation becomes effective upon communication to the Agent and primary health-care provider.

2. Waiver
   No waiver of any provision shall be effective unless in writing and signed by the party waiving.

3. Assignment
   The Agent’s appointment is personal and non-delegable except to the Alternate Agent(s) as set forth herein or by court order.

4. Severability
   Any provision held invalid shall be severed, and the remainder shall remain in full force to the maximum extent permitted.

5. Integration
   This Directive constitutes the entire agreement regarding Health-Care Decisions and supersedes prior inconsistent directives.

6. Counterparts & Electronic Signatures
   This Directive may be executed in counterparts, each of which is an original and all of which together constitute one instrument. Signatures delivered electronically shall be deemed originals.

X. EXECUTION BLOCK

A. Principal’s Signature

I, [PRINCIPAL LEGAL NAME], have read and understand this Directive and hereby execute it as my free and voluntary act.

| ____ | ____ |
| Principal Signature | Date |

Address: [ADDRESS]
Telephone: [PHONE]

B. Agent’s Acceptance

I, [AGENT LEGAL NAME], accept the appointment as Agent under this Directive and agree to act in accordance with its provisions.

| ____ | ____ |
| Agent Signature | Date |

Address: [ADDRESS]
Telephone: [PHONE]

C. Witness Attestation (two adult witnesses OR notarization required)

We declare that the Principal signed or affirmed this Directive in our presence, appears to be of sound mind, and is not acting under duress, fraud, or undue influence. We are not the Agent, Alternate Agent, related to the Principal by blood or marriage, entitled to any portion of the Principal’s estate, or directly financially responsible for the Principal’s health care.

D. Notary Acknowledgment (optional in lieu of witnesses)

State of Mississippi
County of ____

On this _ day of _, 20__, before me, the undersigned Notary Public, personally appeared [PRINCIPAL NAME], proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to this instrument, and acknowledged executing the same for the purposes herein contained.

| ____ | ____ |
| Notary Public | My commission expires |

(Seal)

[// GUIDANCE: Attach Schedules as needed:
• Schedule 1 – Detailed Living Will Provisions
• Schedule 2 – List of Interested Persons to Receive Notice
Ensure the final document reflects client-specific selections and is consistent with Mississippi statutory requirements.]