Free Texas Medical Power of Attorney Form - PDF Form Download
Advance Directives Act §166.163, Health and Safety Code permit you to issue Texas Medical Power of Attorney to appoint an agent to make health care decision for you when you are declared incompetent to do so by a physician in writing. Please read the form and instructions carefully before proceeding.
You, your nominated agent, and physician must sit together and discuss the scope of powers granted to the agent including and not limited to life-sustaining treatment/s. This medical power of attorney remains in force forever unless a natural termination date is specified and/or your revoke it orally or in writing. You may choose to appoint alternate agent/s using a provision in this form. Please seek advice from a lawyer in case you do not understand any term or its consequences prior to executing this document. Please handover copies of this document to your physician and agent and mention their names in the power of attorney.
Steps To Prepare Texas Medical Power Of Attorney
- Enter your legal name on the foremost line of the medical power of attorney.
- Continue by providing the name of the agent, agent’s address, and phone number on the respective lines.
- You may choose to limit agent’s decision-making abilities by providing special instructions. Please provide descriptive instructions, as health care is a subjective term with broad scopes.
- Please enter the name, address, and phone number of first alternate agent in case you intend to appoint so.
- You may opt to nominate a second alternate agent by providing his/her name, address, and phone number on the respective lines. Please select your agent/s carefully.
- Please mention the place where this original Texas Medical Power of Attorney is kept on the next line.
- Enter name of up to two individuals and/or institutions that have a signed copy of this medical power of attorney. Please use separate lines to enter details of each person or institution. It is strongly advisable to handover a copy of the power of attorney to your physician or health care provider and mention the name in the form.
- Please enter a date of natural termination of this Texas Medical Power of Attorney in case you do not grant the powers to the agent forever. You may strike out or leave blank otherwise.
- You may select to terminate/revoke any / all previously issued medical power of attorneys by signing this form before two witnesses to execute it.
- Please enter date in the required format, then name of the state and city, and your printed name on the respective lines. You must sign this Texas Medical Power of Attorney document before two adult and neutral witnesses as required by the law.
- Both your witnesses must sign this form after entering date, print name, and address on separate lines for execution of the Texas Medical Power of Attorney.