Fill Texas Medical Power of Attorney (MPOA) online
Medical Power of Attorney Designation of Health Care Agent
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Texas Medical Power of Attorney (MPOA) in short
The Texas Medical Power of Attorney lets an adult name an agent to make health care decisions if a doctor certifies in writing that the person can no longer make them. It follows the form in Section 166.164 of the Texas Health and Safety Code. Texas HHS publishes it free in English and Spanish.
| Issued by | Texas Health and Human Services Commission (HHSC) |
|---|---|
| Current version | 05-2024 (checked 2026-10-25) |
| Who fills it in | Any adult in Texas who wants to choose a health care agent. Under the statute, an adult is 18 or older, or under 18 with the disabilities of minority removed. |
| Who receives it | It is not filed with the state. The disclosure statement says to give signed copies to your agent and your physician, and to list on the form who holds signed copies. |
| Where to send it | Not sent to any agency. Keep the original and give signed copies to your agent, your doctor and any other people or institutions you list on page 1. |
| Deadline | No deadline. The form must be signed while you are able to make your own decisions. |
| Official links | Official page · Official PDF |
What changed
The HHS form page lists an effective date of 5/2024 and the PDF footer reads 05-2024. The HHS advance directives page says Texas law now allows a notary acknowledgment instead of witnesses, and digital or electronic signatures if certain requirements are met.
How to fill out Texas Medical Power of Attorney (MPOA), line by line
| Page 1 | Your name and your agent Write your name, then the name, address and phone number of the person you appoint as your agent. |
| Page 1 | Limitations on the agent's authority Optional. Write any health care decisions you do not want your agent to make, or any limits on them. Leave it blank if you want no limits. |
| Page 1 | First and second alternate agents Optional. Alternates act in the order listed if your agent is unable or unwilling to act. |
| Page 1 | Where the original is kept and who has copies Say where the original is stored and list the people or institutions that have signed copies. |
| Page 2 | Duration The form lasts indefinitely unless you write an end date. If you cannot make decisions when it ends, it continues until you can. |
| Pages 2 to 3 | Disclosure statement Read it before signing. By signing you confirm you have read and understood it. |
| Page 3 | Signature acknowledged before a notary Option 1. Sign and date in front of a Texas notary, who completes the acknowledgment. |
| Page 4 | Signature with two witnesses Option 2. Sign in the presence of two competent adult witnesses. The first witness signs a statement confirming they are not in any of the barred groups. |
Common mistakes to avoid
- Using a notary and no witnesses but skipping the notary acknowledgment block, or using witnesses and leaving the witness statements blank. You need one complete option.
- Choosing a first witness who is your agent, a relative, an heir, your attending physician or their employee, or someone with a claim against your estate.
- Naming your doctor or an employee of your health or residential care provider as agent without knowing they cannot act as both agent and provider at the same time (unless they are a relative).
- Trying to change the signed form. The disclosure statement says it may not be changed; you must sign a new medical power of attorney.
- Not telling your agent or doctor and not giving them signed copies.
- Assuming it covers money or property. It only covers health care decisions. Property needs a separate document such as the Statutory Durable Power of Attorney.
Questions about Texas Medical Power of Attorney (MPOA)
When does a Texas medical power of attorney take effect?
The agent can act only after your attending physician certifies in writing, in your medical record, that you are not competent to make health care decisions. Until then you make your own decisions.
Does it need a notary?
No. You can either sign in front of two competent adult witnesses or have your signature acknowledged by a notary public. At least one witness must not be in the barred groups listed on the form.
Who can be my agent?
An adult you trust. A person cannot act as your agent while they are your health care or residential care provider, or an employee of that provider, unless they are your relative.
What can my agent not consent to?
Under Section 166.152, an agent may not consent to voluntary inpatient mental health services, convulsive treatment, psychosurgery, abortion, or neglect through omission of comfort care.
How do I revoke it?
Tell your agent or a licensed health or residential care provider, orally or in writing, or sign a new medical power of attorney. Naming your spouse is revoked if the marriage is dissolved, annulled or declared void, unless the document says otherwise.
Can I sign it electronically?
Texas law allows digital or electronic signatures on the medical power of attorney if the requirements in Health and Safety Code Section 166.011 are met. Rules vary by situation. Check the official statute and guidance linked on this page before you sign.
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Sources
Checked against the official sources on 2026-10-25. PDF Editor Hub is not affiliated with the Texas Health and Human Services Commission or any government agency. This page is general information, not legal or tax advice.
- https://fhb.hhs.texas.gov/forms/advance-directives/medical-power-attorney-designation-health-care-agent-mpoa
- https://fhb.hhs.texas.gov/sites/default/files/documents/medical-power-of-attorney-designation-of-health-care-agent-mpoa-english.pdf
- https://fhb.hhs.texas.gov/forms/advance-directives
- https://statutes.capitol.texas.gov/Docs/HS/htm/HS.166.htm
- https://www.hhs.texas.gov/policies-practices-privacy