Texas Durable Medical Power of Attorney Form

The Texas Power Of Attorney Form allows another appointed person or, also referred to as the`Agent`, to make decisions over a patient`s health care treatment. If this agent becomes unavailable another agent is also able to become the principals medical power of attorney. This authority can be out right or can be limited by the principal for use. The document is in accordance with statutes §166.001 to -.166 in the state of Texas, requires either a notary or two witnesses and is invalid when the principal becomes pregnant.

How to Write

Medical Power Of Attorney Form Designation Of Health Care Agent

The principal must enter their and their agent`s details.

  • Principals name.
  • Agent`s name.
  • Agent`s address.
  • Agent`s telephone number.


Limitations To Agent`s Authority

The principal may enter any details regarding their wishes to any specific limitations they wish to apply to the agent`s authority.


Alternative Agents

The alternative agent`s details must be entered.

  • Agent`s name.
  • Agent`s address.
  • Agent`s telephone number.


Original Document And Copies

The location of the keeping of the original document and any copies must be entered.

  • Location of original.
  • Name of person holding copy.
  • Address of person holding copy.
  • Telephone number of person holding copy.



The principal may if they wish set a date when the durable power of attorney document becomes invalid.



The principal must enter their details.

  • Date.
  • County.
  • Signature of principal.
  • Name of principal


Statement Of Witnesses

The witnesses details must be entered.

  • Signature.
  • Name.
  • Address.
  • Date.