The Texas Medical Power of Attorney designates an agent to operate on behalf of the individual carrying out the instrument regarding medical care. The document only goes into effect if the appointing party ever winds up in a state where they cannot make sound decisions for themselves (either because they are unconscious or mentally impaired). In order to properly establish this relationship, the principal will have to deliver the form with:
- Details regarding both parties (and that of any alternate agents if applicable);
- Any limitations of power;
- Location of where the original document will be stored;
- Identities of any individuals and/or institutions who will receive a copy;
- The expiration date of the POA (if desired);
- & their signature which is to be acknowledged by two (2) witnesses or a notary public.
Laws
Statute – § 166.164
Definition – “Medical power of attorney” means a document delegating to an agent the authority to make health care decisions executed or issued under Subchapter D (§ 166.002(11)).
Signing Requirements – Acknowledgment of Two (2) Witnesses or Notary Public (§ 166.154)
Other Versions (5)
Download: Adobe PDF
Download: Adobe PDF
Download: Adobe PDF
Texas Hospital Association Version
Download: Adobe PDF, MS Word (.docx)
Texas Medical Association Version
Download: Adobe PDF
Additional Resources
- Texas Medical Association – Information for Patients
Related Forms (8)
- Advance Directive (Medical POA & Living Will)
- Advance Directive Wallet Card
- Appointment for Disposition of Remains
- Declaration for Mental Health Treatment
- Durable (Financial) Power of Attorney Form
- HIPAA Authorization to Disclose Protected Health Information
- Organ Donation Form
- Out-of-Hospital Do-Not-Resuscitate (OOH-DNR) Order
Advance Directive (Medical POA & Living Will)
Download: Adobe PDF, MS Word (.docx)
Download: Adobe PDF
Appointment for Disposition of Remains
Download: Adobe PDF, MS Word (.docx)
Declaration for Mental Health Treatment (also available in Spanish/en Español)
Download: Adobe PDF
Laws: Adobe PDF
Durable (Financial) Power of Attorney
Download: Adobe PDF, MS Word (.docx)
HIPAA Authorization to Disclose Protected Health Information
Download: Adobe PDF, MS Word (.docx)
Download: Adobe PDF
Out-of-Hospital Do-Not-Resuscitate (OOH-DNR) Order
Download: Adobe PDF
Instructions: Adobe PDF (in Spanish/en Español)