Health care directive in Texas: form, signing and who decides
The form, who can witness, who can be your agent and who decides if you have no directive in Texas.
Checked against official sources: October 31, 2026.
Short answer
Medical Power of Attorney (Designation of Health Care Agent)
- How to sign
- Notarized or signed by two adult witnesses
- Who decides without a directive
- Yes
The document and its form
- Document
- Medical Power of Attorney (Designation of Health Care Agent)
- Official form
- Medical Power of Attorney Designation of Health Care Agent (MPOA)Published by Texas Health and Human Services CommissionVersion: 05-2024 (printed in the form footer)
You do not have to use it.
- Living will
Directive to Physicians and Family or Surrogates
The living will is a separate document.
The directive states your wishes about life-sustaining treatment if you have a terminal or irreversible condition. You can also name a person in it to make treatment decisions. It is signed with two qualified witnesses or before a notary. Doctors and facilities may not require it to be notarized or require their own form. Tell your attending physician that you have one.
Law: Tex. Health & Safety Code §§ 166.154, 166.164; Tex. Health & Safety Code §§ 166.032, 166.033, 166.036
Signing rules
- How to sign
Sign the medical power of attorney in front of two qualified adult witnesses, who also sign, or instead sign it and have your signature acknowledged by a notary public. The same rule applies to the directive to physicians.
- Who signs
Signed by you. If you are physically unable to sign, another person may sign your name in your presence and at your express direction.
- Notary
- A notary or witnesses (your choice)
- Witnesses
- 2 (instead of a notary)
- Who cannot witness
Each witness must be a competent adult. At least one of the two witnesses must NOT be: your health care agent; related to you by blood or marriage; entitled to part of your estate by will or by law; your attending physician or the physician's employee; an employee of a health care facility where you are a patient who gives you direct care, or an officer, director, partner or business office employee of the facility; or someone with a claim against your estate.
- Electronic signing
You, the witnesses or a notary may sign a medical power of attorney, directive to physicians, or a written revocation with a digital or electronic signature that meets the rules in Health and Safety Code 166.011 (verifiable, under the signer's sole control, and invalidated if the data changes).
Law: Tex. Health & Safety Code §§ 166.003, 166.011, 166.032, 166.154
Who can be your agent and what the agent can do
- Who cannot be your agent
While serving in that role, these people may not act as your agent: your health care provider; an employee of your health care provider unless related to you; your residential care provider; an employee of your residential care provider unless related to you.
Law: Health & Safety Code 166.153
- When the agent starts
The agent can act only after your attending physician certifies in writing, in your medical record, that you are incompetent. Treatment may not be given or withheld over your objection, even then. The medical power of attorney stays in effect until you revoke it; if it has an expiration date and you are incompetent on that date, it continues until you regain competence.
Law: Health & Safety Code 166.152
- Decisions an agent cannot make
An agent may not consent to voluntary inpatient mental health services, convulsive treatment, psychosurgery, abortion, or neglect through leaving out care mainly meant for your comfort.
Law: Health & Safety Code 166.152(f)
Revoking and conflicting documents
- Revoking your agent
You can revoke a medical power of attorney at any time, whatever your mental state, by telling your agent or a licensed health or residential care provider, orally or in writing, by any other act that shows you intend to revoke it, or by signing a new medical power of attorney.
- Revoking your instructions
You can revoke a directive to physicians at any time, whatever your mental state, by destroying it (or having someone do so in your presence at your direction), by signing and dating a written revocation, or by saying you revoke it. A written or oral revocation takes effect when your attending physician is told about it (or a written one is mailed to the physician).
- Telling others
A provider who learns of the revocation of a medical power of attorney must record it in your medical record and notify the agent and your other known providers.
- Divorce ends a spouse's authority
- Yes · Divorce rules in Texas (Divorce Law Map)
- Conflicting documents
If two advance directives or treatment decisions conflict, the one made later controls.
Law: Health & Safety Code 166.008
Law: Tex. Health & Safety Code §§ 166.042, 166.155
If you have no directive
- Who decides without a directive
If you are in a hospital, nursing home, or with a home and community support services agency, cannot communicate, and have no guardian or medical power of attorney agent reasonably available, an adult from this list, in this order, may consent to medical treatment for you. A surrogate may not consent to voluntary inpatient mental health services or electro-convulsive treatment. For decisions about life-sustaining treatment when you have no directive, the attending physician and one person from the same list, in the same order, make the decision. Disputes about who may act go to a court that hears guardianship cases.
- Spouse
- Adult children
- Parents
- Nearest living relative
Law: Tex. Health & Safety Code §§ 166.039, 313.004
Other states, registry and medical orders
- Signed in another state
An advance directive validly made in another state has the same effect in Texas as one made under Texas law, but it cannot authorize care that Texas law prohibits.
Law: Health & Safety Code 166.005
- Mental health directive
You can sign a Declaration for Mental Health Treatment covering psychoactive medication, convulsive treatment and emergency mental health treatment. It must be signed with two witnesses or acknowledged before a notary. A witness cannot be your health or residential care provider or their employee, a facility operator or employee, a relative by blood, marriage or adoption, an heir or beneficiary, or someone with a claim against your estate. It expires after 3 years unless you are incapacitated at that time.
Law: Civil Practice and Remedies Code 137.002, 137.003
Free notice: revoke or change a health care directive
Free help in Texas
- TexasLawHelp.org (Texas Legal Services Center) - legal help directory
- Texas HHS Forms: Advance Directives (medical power of attorney, directive to physicians, mental health declaration, statutory durable power of attorney, out-of-hospital DNR)
- TexasLawHelp.org: Guardianship
- TexasLawHelp.org: Alternatives to guardianship (supported decision-making)
- TexasLawHelp.org: Advance directives
Report abuse or exploitation
Texas Abuse Hotline (Department of Family and Protective Services, Adult Protective Services) · 1-800-252-5400
Questions about powers of attorney in Texas
How do I sign a health care directive in Texas?
Sign the medical power of attorney in front of two qualified adult witnesses, who also sign, or instead sign it and have your signature acknowledged by a notary public. The same rule applies to the directive to physicians.
Who decides my health care if I have no directive in Texas?
If you are in a hospital, nursing home, or with a home and community support services agency, cannot communicate, and have no guardian or medical power of attorney agent reasonably available, an adult from this list, in this order, may consent to medical treatment for you.