Texas Medical Power Of Attorney

Information you will need

• Principal Name
• Agent Name
• Agent Address
• Agent Phone Number
• Agent Limitations
• First Alternate Agent Name
• First Alternate Agent Address
• First Alternate Agent Phone
• Second Alternate Agent Name
• Second Alternate Agent Address
• Second Alternate Agent Phone
• Original Document Location
• Copyholder (1) Name
• Copyholder (1) Address
• Copyholder (2) Name
• Copyholder (2) Address
• Expiration Date
• Principal Signing Day
• Principal Signing Month/Year
• Principal City/State
• Notary Public Only: County
• Notary Public Only: Date
• Notary Public Only: Principal Name
• Notary Public Only: Notary Name

…and 9 more fields in the PDF.

Completed by the agent and the employee and the principal.

The form includes 1 signature line, a notary acknowledgment, a witness section.

The document text refers to the laws of Texas.