The Texas Medical Power of Attorney form is a legal document allowing individuals to appoint someone they trust to make healthcare decisions on their behalf if they become unable to do so themselves. This form serves as a critical tool for ensuring that a person's healthcare preferences are honored. Understanding how to properly complete and utilize this form is essential for all Texas residents planning for their future healthcare needs.
Navigating the realm of medical decisions when an individual is unable to make them on their own can be a daunting process. The Texas Medical Power of Attorney form serves as a critical tool in this journey, enabling individuals to appoint someone they trust to make health care decisions on their behalf should they become incapacitated. This document provides a clear and legal pathway for chosen representatives to follow the wishes of the person they are representing, concerning medical treatments and interventions. Through the completion and proper execution of this vital document, individuals can ensure that their health care preferences are known and respected, even when they can no longer communicate their wishes directly. This form not only brings peace of mind to the person it covers but also serves as guidance for families during challenging times, ensuring that medical decisions are made in line with what their loved one would have wanted.
Texas Medical Power of Attorney
This Texas Medical Power of Attorney is a legal document that allows you to designate an individual, known as your Agent, to make health care decisions on your behalf should you become unable to make them yourself. This document is governed by the laws of the State of Texas, specifically the Texas Health and Safety Code, Chapter 166. This authority grants your Agent the power to make health care decisions that align with your wishes and values, ensuring that your healthcare providers follow your instructions.
Please Fill In The Blanks With The Relevant Information:
Principal's Full Name: _______________________________
Principal's Address: __________________________________
Principal's Contact Number: ___________________________
Agent's Full Name: ___________________________________
Agent's Address: _____________________________________
Agent's Contact Number: _____________________________
Alternate Agent (Optional): If the primary Agent is unable or unwilling to serve, you may designate an alternate Agent.
Alternate Agent's Full Name: __________________________
Alternate Agent's Address: ____________________________
Alternate Agent's Contact Number: _____________________
Scope of Authority: This Medical Power of Attorney becomes effective upon the incapacitation of the Principal and grants the Agent the same rights to request or refuse treatment that the Principal would have if capable of making and communicating health care decisions.
Limitations: The Agent's authority is subject to any limitations or restrictions set forth below:
______________________________________________________
Your designated Agent will not be compensated for their services but will be entitled to reimbursement for all reasonable expenses incurred as a result of carrying out any decision or action on your behalf.
Signatures:
This document must be signed by the Principal, or an adult on the Principal’s behalf in the Principal's presence and by the Principal's direction. This document must also be notarized or signed by two competent adult witnesses.
Acknowledgement by Principal
Principal's Signature: _________________________________
Date: __________________
Statement by Witnesses
Witness 1 Signature: _________________________________
Date: _______________
Witness 1 Printed Name: ______________________________
Witness 2 Signature: _________________________________
Witness 2 Printed Name: ______________________________
Notarization (If Applicable):
(The Notary Public must complete this section)
State of Texas )
County of ___________ )
Subscribed and sworn before me on the ______ day of ___________, 20__, by _________________________, the Principal, and witnessed by ______________________ and ________________________, on this day personally appeared before me.
Notary Public's Signature: ____________________________
Notary Public's Printed Name: _________________________
My Commission Expires: _______________________________
In Texas, the Medical Power of Attorney (MPOA) form is a legal document that allows you to appoint someone you trust to make healthcare decisions on your behalf in the event you are unable to communicate your wishes. This preparation can be an empowering step, ensuring that your healthcare preferences are honored, even when you cannot voice them yourself. The completion of this form requires careful thought and consideration, as well as a clear understanding of the steps involved in its execution. The instructions below aim to guide you through this process smoothly.
Filling out the Texas Medical Power of Attorney form is a forward-thinking action that can ensure your healthcare decisions are in trusted hands, even when you are not in a position to make those decisions yourself. It's a process that merits thorough attention and discussion with those you love and trust, ensuring that everyone involved understands your wishes and the responsibilities granted by this powerful legal document.
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