Texas Medical Power of Attorney Form

Signing the Texas Medical Power of Attorney form allows you to appoint another person to make health care related decisions on your behalf when you are no longer capable of making those decisions. Your agent has the rights and authority to consent any type of medical treatment which you may require, however the agent does not have the authority to consent to voluntary inpatient mental health services, abortion etc. The agent may start making decisions when your attending physician certifies that you are no longer capable of making your own decisions.

How to Fill the Texas Medical Power of Attorney Form

Begin this document by carefully reading all the important facts and instructions given in the beginning to understand the importance of appointing such a power of attorney.

Then initiate the actual form with the full and legal name of the grantor (first, middle, last) followed by their full and legal name, the complete address with the city, state, zip code and phone number of the individual they wish to appoint as their agent.

This agent shall be authorized to represent the grantor in all the matters related to their health care except for the ones they are restricted for. This power shall take effect once the grantor is incapable to take decisions for themselves and when their physician gives the same in writing.

After that, decisions or matters the grantor wishes to restrict the agent from, must be stated in the field given.

In the next section the grantor must provide the details of two alternate agents who shall become active when the primary agent is unwilling, unable or incapable to take the decisions for any given reason. All the restrictions imposed on the primary agent shall also be applicable to the alternate agents too. Their details should include their full name, complete address, and phone number.

Later, the complete address where this original document is kept must be written. Then the name and address of the individual or institution which has the signed copies must also be provided.

This power of attorney has an indefinite duration and if the grantor wishes to provide the end date, the same can be done on the field given.

By assigning this agent as their medical power of attorney they also revoke any prior agents in matters related to health care.

Lastly, this document must be dated, named & signed by the grantor followed by similar details of two witnesses.

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Texas Medical Power of Attorney Form

Preview Texas Medical Power of Attorney Form

Texas Medical Power of Attorney Form