Medical Power Of Attorney And Texas Will To Live printable pdf download

SUGGESTIONS & REQUIREMENTS

For Medical Power of Attorney & Completing the Texas Will to Live Form

1. This Medical Power of Attorney (also known as the Health Care Agent Designation Form) allows you to

designate a health care agent who will make health care decisions for you whenever you are unable to

make them for yourself; these forms allow you to direct your medical care through your health care agent.

Any person who is at least 18 years old may designate a health care agent through this document.

2. Carefully read the “Information Concerning the Medical Power of Attorney.” Sign and date the form to

show you have done so. This form explains the witnessing requirements and eligibility restrictions for

your health care agent.

3. You must sign this Medical Power of Attorney in the presence of two witnesses who must also sign the

document. Each witness must be a competent adult, and at least one of the witnesses must be a person

who is NOT one of the following:

a. the person you have designated as your health care agent,

b. a person related to you by blood or marriage,

c. a person entitled to any part of your estate after your death under a will or codicil executed

by you or by operation of law,

d. your attending physician,

e. an employee of your attending physician,

f. an employee of a health care facility in which you are a patient if the employee is providing

direct patient care to you,

g. an officer, director, partner, or business office employee of the health care facility or parent

organization of the health care facility providing care to you, or

h. a person who, at the time this Medical Power of Attorney is executed, has a claim against

any part of your estate after your death.

4. You may not appoint your physician, residential care provider, or an employee of your physician or

residential care provider as your health care agent unless that person is your relative.

5. An alternate health care agent(s) should be designated who can to take over if your first designee is unable

to serve. Space is provided on the form for this alternate designation. The same rules apply to the

alternate health care agent as for the primary health care agent.

6. If you physically cannot sign this document, another person may sign your name for you at your express

direction in your presence and in the presence of your two witnesses.

7. Tell your doctor and your attorney about this document. Also ask your doctor to keep a copy of this

document as a part of your medical health record. Your attorney may wish to keep a copy also.

8. This type of document has been authorized by the “Advance Directives Act” of the Texas Health and

Safety Code, §§166.001 through 166.010 and §§166.151 through 166.166.

9. If you have any questions about this document, or want assistance in completing it, please consult an

attorney. Texas Right to Life can offer referrals to attorneys.

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Medical Power Of Attorney And Texas Will To Live