Texas Medical power of attorney
An appointment for health care decisions under the state's rules.
Sources reviewed 2026-10-01. Independently formatted PDF.
Before you sign
- Which document is this?
- Health and Safety Code 166.164 publishes the medical power of attorney and disclosure. The agent acts when the physician certifies inability to make health care decisions; the document includes the principal's limitations, alternates and duration. Source
- Execution and disclosures
- Section 166.154 allows signing before two qualified witnesses, at least one satisfying the disinterested-witness qualifications, or acknowledgment before a notary instead. Read the full disclosure and the first-witness statement before choosing the signing alternative. Source
Read it carefully.
Make it specific.
Use the blank PDF or fill in the reviewed fields. Complete all paper choices, addenda and execution steps.
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Texas Medical power of attorney
1. Parties
Names, addresses and the actual appointment or dwelling
2. Terms and instructions
Your details, source-based text and disclosure checklist
3. Review and execution
Paper choices, applicable signing alternatives and sources
What to fill in
- Your full legal name
- Your address
- Agent full legal name
- Agent address
- Agent phone
- First alternate agent name
- First alternate agent address
- First alternate agent phone
- Second alternate agent name
- Second alternate agent address
- Second alternate agent phone
- Your special instructions or limitations
- Where the original will be kept
- People or institutions receiving signed copies
- Optional expiration date
- Paper signing and disclosure review
Details to check in Texas
- The medical agent cannot be an ineligible health or residential care provider under 166.153; check the relationships and exceptions in the source. Source
- Two witnesses and a notary are alternatives under 166.154. Witness qualifications apply to the witness option and are printed in the PDF. Source
- Section 166.155 addresses revocation and the effect of ending a marriage to the agent. Giving someone an unsigned PDF is not execution. Source
Questions about this document
Is this a free medical power of attorney form?
The blank PDF and fill-in builder are free. The PDF is independently formatted. Read the official source and consult a lawyer before relying on it.
Does this Texas form need a notary or witnesses?
Section 166.154 allows signing before two qualified witnesses, at least one satisfying the disinterested-witness qualifications, or acknowledgment before a notary instead. Read the full disclosure and the first-witness statement before choosing the signing alternative. Source
What does the official statutory source cover?
Health and Safety Code 166.164 publishes the medical power of attorney and disclosure. The agent acts when the physician certifies inability to make health care decisions; the document includes the principal's limitations, alternates and duration. Source
Does filling in the builder complete or sign the document?
The builder fills the reviewed details and streams a PDF. It does not apply signatures, initials or certify that the disclosure steps happened. Read the entire PDF and complete the required paper choices and execution.
Are my details or completed PDF saved?
The application processes this request in memory and streams the PDF. It does not save your completed document or form contents. The Start over link opens a fresh blank builder.
Sources for this page
- tcss.legis.texas.gov/resources/HS/htm/HS.166.htmReviewed 2026-10-01