(1) the name and address of the person who meets the requirements of § 62-5-503 and is authorized to make health care related decisions if the principal becomes mentally incompetent;

(2) the types of health care related decisions that the health care agent is authorized to make;

(3) the signature of the principal;

(4) the signature of at least two persons who witnessed the principal’s signature and who meet the requirements of § 62-5-503; and

(5) the attestation of a notary public.

(b) Additionally, a document that meets the above requirements and also provides expressions of the principal’s intentions or wishes with respect to the following health care issues authorizes the health care agent to act in accordance with these provisions:

(1) organ donations;

(2) life-sustaining treatment;

(3) tube feeding;

(4) other kinds of medical treatment that the principal wishes to have or not to have;

(5) comfort and treatment issues;

(6) provisions for interment or disposal of the body after death; and

(7) any written statements that the principal may wish to have communicated on his behalf.