If you designate an alternate agent the alternate agent has the same authority as the agent to make health care decisions for you.
Medical power of attorney designation of health care agent texas.
Medical power of attorney designation of health care agent.
Medical power of attorney form designation of health care agent i insert your.
This medical power of attorney takes effect if i become unable to make my own health care decisions and this fact is certified in writing by my physician.
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Acknowledgment of disclosure statement.
An alternate agent may make the same health care decisions as the designated agent.
The exact decision making responsibilities depend on what the patient instructs in the document.
You may wish to designate an alternate agent in the event that your agent is unwilling unable or ineligible to act as your agent.
B a principal s licensed or certified health or residential care provider who is informed of or provided with a revocation of a medical power of attorney shall immediately record the revocation in the principal s medical record and give notice of the revocation to the agent and any known health and residential care providers currently.
Designation of alternate agent you are not required to designate an alternate agent but you may do so.
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The medical power of attorney is appointed by you in a legal document to make medical decisions for you 1 which indicates what course to take in specific medical circumstances.
If applicable this power of attorney ends on the following date.
Prior designations revoked i revoke any prior medical power of attorney.
I name of principal appoint name address and telephone number of agent as my agent to make any and all health care decisions for me except to the extent i state otherwise in this document.
This medical power of attorney takes effect if i become unable to.
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Similar to this example you must provide a document with the following complete details.
As my agent to make any and all health care decisions for me except to the extent i state otherwise in this document.
Power of attorney expires the authority i have granted my agent continues to exist until the time i become able to make health care decisions for myself.
Explanation regarding the medical power of attorney designation of health care agent effectiveness of appointment revocation general statement of authority granted special provisions and limitations organ donation guardianship provision reliance of.