Page 1 of 8
SUGGESTIONS & REQUIREMENTS
For Medical Power of Attorney & Completing the Texas Will to Live Form
1. This Medical Power of Attorney (also known as the Health Care Agent Designation Form) allows you to
designate a health care agent who will make health care decisions for you whenever you are unable to
make them for yourself; these forms allow you to direct your medical care through your health care agent.
Any person who is at least 18 years old may designate a health care agent through this document.
2. Carefully read the “Information Concerning the Medical Power of Attorney.” Sign and date the form to
show you have done so. This form explains the witnessing requirements and eligibility restrictions for
your health care agent.
3. You must sign this Medical Power of Attorney in the presence of two witnesses who must also sign the
document. Each witness must be a competent adult, and at least one of the witnesses must be a person
who is NOT one of the following:
a. the person you have designated as your health care agent,
b. a person related to you by blood or marriage,
c. a person entitled to any part of your estate after your death under a will or codicil executed
by you or by operation of law,
d. your attending physician,
e. an employee of your attending physician,
f. an employee of a health care facility in which you are a patient if the employee is providing
direct patient care to you,
g. an officer, director, partner, or business office employee of the health care facility or parent
organization of the health care facility providing care to you, or
h. a person who, at the time this Medical Power of Attorney is executed, has a claim against
any part of your estate after your death.
4. You may not appoint your physician, residential care provider, or an employee of your physician or
residential care provider as your health care agent unless that person is your relative.
5. An alternate health care agent(s) should be designated who can to take over if your fi