Medical Power Of Attorney And Texas Will To Live (Page 7 of 8) in pdf

Medical Power Of Attorney And Texas Will To Live Page 7

B. Second Alternate Health Care Agent

(Name)__________________________________________________________________________________

(Address)________________________________________________________________________________

________________________________________________________________________________________

(Phone Number)___________________________________________________________________________

The original of this document is kept at the following location:

________________________________________________________________________________________

The following individuals or institutions are in possession of additional signed copies:

Name___________________________________________________________________________________

Address_________________________________________________________________________________

Name___________________________________________________________________________________

Address_________________________________________________________________________________

DURATION

I understand that this Medical Power of Attorney exists indefinitely from the date I execute this document

unless I establish a shorter time or revoke this Medical Power of Attorney. If I am unable to make health care

decisions for myself when this document expires, the authority granted to my health care agent lasts until the

time I become able to make health care decisions for myself. (IF APPLICABLE) This Medical Power of

Attorney ends on the following date:

________________________________________________________________________________________

PRIOR DESIGNATIONS REVOKED

I revoke any prior Medical Powers of Attorney and Health Care Agent Designations.

Page 7 of 8

Medical Power Of Attorney And Texas Will To Live Page 7