Texas Medical Power of Attorney
This Texas Medical Power of Attorney allows you to designate someone to make medical decisions on your behalf if you are unable to do so. This document is governed by Texas law.
Principal Information:
- Name: ___________________________________
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- City, State, Zip Code: _______________________
- Phone Number: ______________________________
Agent Information:
- Name: ___________________________________
- Address: ___________________________________
- City, State, Zip Code: _______________________
- Phone Number: ______________________________
Durability:
This Power of Attorney is effective immediately and will remain in effect until revoked or until my death.
Medical Decisions:
The agent has the authority to make decisions regarding my medical treatment, including but not limited to:
- Choosing healthcare providers.
- Deciding on medical procedures.
- Accessing my medical records.
- Making decisions about life-sustaining treatment.
Signatures:
By signing below, I confirm that I understand this document and wish to appoint the above-named agent to make medical decisions on my behalf.
Principal Signature: ___________________________ Date: _______________
Agent Signature: _____________________________ Date: _______________
Witnesses:
This document must be signed in the presence of two witnesses who are at least 18 years old and not related to the principal or agent.
- Witness 1 Name: ___________________________ Signature: _______________ Date: _______________
- Witness 2 Name: ___________________________ Signature: _______________ Date: _______________
Notary Public:
State of Texas
County of ____________________________
Subscribed and sworn to before me on this _____ day of ______________, 20__.
Notary Public Signature: ___________________________
My Commission Expires: ___________________________