Click to view
"State of County of On this day of , in the year , before me, (insert name of notary public) appeared , personally known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to this instrument, and acknowledged that he or she executed it. I declare under the penalty of perjury that the person whose name is subscribed to this instrument appears to be of sound mind and under no duress, fraud or undue influence. Notary Seal (Signature of Notary Public)"
Structure Mississippi Code
Chapter 41 - Surgical or Medical Procedures; Consents
Uniform Health-Care Decisions Act
§ 41-41-209. Form for Advance Health-Care Directive
§ 41-41-217. Rights to disclosure of medical and health-care information
§ 41-41-225. Copies have same effect as originals
§ 41-41-229. Equitable relief; Rules of Civil Procedure applicable