Texas Medical Power of Attorney Form

What a medical power of attorney does

The HHS May 2024 form names someone to make health care decisions when its activation conditions are met. It differs from a living will recording treatment preferences and from a financial power of attorney. Read the disclosure statement before completing the appointment.

Sources: [1] [2]

Information to prepare

Prepare current contact details for your agent and any alternates. Record decision limits, the original’s location, recipients of copies and any chosen expiration date. Discuss your preferences with the agent and clinician. The form revokes earlier medical powers of attorney, so review that effect before replacing an existing appointment.

Sources: [4]

When the agent can make decisions

Under §166.152, the attending physician must certify incompetence in writing and place that certification in the medical record before the agent exercises authority. Signing alone does not activate the agent. Texas law preserves your right to object to treatment even when considered incompetent.

Section 166.153 restricts appointing certain health or residential care providers and their employees; check the disclosure before naming someone in those roles.

Sources: [3]

Sign correctly and distribute complete copies

Choose notarial acknowledgment or two qualifying adult witnesses. Under §§166.154 and 166.003(2), at least one witness must meet additional independence requirements. Page 3 contains the notary section; page 4 contains the witness declarations. Read those declarations before selecting witnesses.

Give complete signed copies to the agent and relevant providers. The disclosure instructs you to execute a new document for changes. Section 166.155 describes revocation methods, including notifying the agent or a qualifying provider.

Sources: [3] [4]

Related forms and guides

• Texas Power of Attorney Forms
• Texas Statutory Durable Power of Attorney Form
• Medical Power of Attorney and Health Care Proxy Forms
• Medical vs. Financial Power of Attorney

Sources and verification

1. Texas Health and Human Services: source and instructions ↗ (opens in a new tab)
2. Texas State Law Library — medical powers of attorney ↗ (opens in a new tab)
3. Texas Health and Safety Code Chapter 166 ↗ (opens in a new tab)
4. Official form file inspected ↗ (opens in a new tab)

Publisher source and document inspected. This is source research, not independent attorney review.

The date above records a source check. It does not certify that a form is suitable for your circumstances or that an attorney has reviewed your document. Read the publisher’s current instructions before use.