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.

Other Versions (5)

• Spanish/Español
• Texas Catholic
• Texas Health
• Texas Hospital Association
• Texas Medical Association

Spanish/Español Version

Download: Adobe PDF

 

 

 

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Texas Catholic Version

Download: Adobe PDF

 

 

 

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Texas Health Version

Download: Adobe PDF

 

 

 

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Texas Hospital Association Version

Download: Adobe PDF, MS Word (.docx)

 

 

 

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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)

 

 

 

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Advance Directive Wallet Card

Download: Adobe PDF

 

 

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Appointment for Disposition of Remains

Download: Adobe PDF, MS Word (.docx)

 

 

 

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Declaration for Mental Health Treatment (also available in Spanish/en Español)

Download: Adobe PDF
Laws: Adobe PDF

 

 

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Durable (Financial) Power of Attorney

Download: Adobe PDF, MS Word (.docx)

 

 

 

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HIPAA Authorization to Disclose Protected Health Information

Download: Adobe PDF, MS Word (.docx)

 

 

 

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Organ Donation Form

Download: Adobe PDF

 

 

 

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Out-of-Hospital Do-Not-Resuscitate (OOH-DNR) Order

Download: Adobe PDF
Instructions: Adobe PDF (in Spanish/en Español)