A Texas advance directive form lets you put your medical wishes in writing before a crisis, and the state recognizes three of them: a Directive to Physicians and Family or Surrogates (the living will), a Medical Power of Attorney, and an Out-of-Hospital Do-Not-Resuscitate Order. You can download all three, in English or Spanish, for free from the Texas Health and Human Services Commission at hhs.texas.gov.1Texas Health and Human Services. Advance Directives No lawyer is required. What you do need is the right form for your situation, accurate information filled in, and a proper signing.
Which Form You Need
The three forms cover different scenarios and work independently. Filling out one does not create another.
- The Directive to Physicians is a living will. It records whether you want life-sustaining treatment continued or stopped if you develop a terminal condition expected to cause death within six months, or an irreversible condition that leaves you unable to care for yourself.2State of Texas. Texas Health and Safety Code 166.032 – Written Directive by Competent Adult, Notice to Physician
- The Medical Power of Attorney appoints someone you trust (your “agent”) to make healthcare decisions for you. Their authority begins only after your attending physician certifies in writing that you cannot make your own decisions.3State of Texas. Texas Health and Safety Code 166.164 – Form of Medical Power of Attorney
- The Out-of-Hospital DNR tells paramedics and first responders not to perform CPR or other resuscitation measures outside a hospital. Unlike the other two, it requires your physician’s signature as well as yours.4State of Texas. Texas Health and Safety Code 166.083 – Form of Out-of-Hospital DNR Order
Most people start with the first two. Together, the living will states your preferences and the agent handles anything the living will does not specifically address.
Filling Out the Directive to Physicians
Any competent adult can execute this form.2State of Texas. Texas Health and Safety Code 166.032 – Written Directive by Competent Adult, Notice to Physician The statutory form gives you two medical scenarios and asks you to pick between two options for each.
The Terminal Condition Section
This covers a situation where your physician expects death within six months even with treatment. Choose either to have all treatments except comfort care stopped, or to be kept alive using available life-sustaining treatment. Selecting continued treatment does not apply to hospice care.5State of Texas. Texas Health and Safety Code 166.033 – Form of Written Directive
The Irreversible Condition Section
This covers a condition where you cannot care for yourself or make decisions and would be expected to die without life-sustaining treatment. Same choice: comfort care only, or continued treatment.5State of Texas. Texas Health and Safety Code 166.033 – Form of Written Directive
Additional Instructions
The form has space for anything the two checkboxes do not cover. You might spell out preferences on artificial nutrition and hydration, pain management, or organ donation. Be specific. Vague language creates exactly the confusion these forms are meant to prevent.
Filling Out the Medical Power of Attorney
You will need your agent’s full name, address, and phone number. The agent takes over healthcare decisions only after your physician certifies that you can no longer make them yourself.3State of Texas. Texas Health and Safety Code 166.164 – Form of Medical Power of Attorney
Choosing an Agent
Pick someone who understands your values, can handle hard conversations with medical staff, and is realistically available. The form has space for one or more alternate agents in case the primary is unavailable, unable, or unwilling. Confirm with each person before you name them.
Scope, Limits, and Duration
By default, your agent can make any healthcare decision you could make yourself. To restrict that authority, use the section for limitations. You might, for example, authorize all decisions except those involving experimental treatment, or prohibit the withdrawal of artificial nutrition.
The Medical Power of Attorney lasts indefinitely unless you write an expiration date on the form. If the document expires while you are incapacitated, the agent’s authority continues until you regain the ability to decide for yourself.3State of Texas. Texas Health and Safety Code 166.164 – Form of Medical Power of Attorney
Medical Records Access
Under federal privacy rules, a healthcare agent with legal authority to make decisions on your behalf is treated as your “personal representative” and can access your medical records without a separate HIPAA authorization.6U.S. Department of Health and Human Services. Does the HIPAA Privacy Rule Permit a Doctor to Discuss a Patients Health Status Some hospitals still ask for a standalone HIPAA release to smooth the process, so including one with your paperwork can prevent front-desk friction.
The Out-of-Hospital DNR
The OOH-DNR is a medical order, not a personal declaration, and your attending physician must sign it alongside you (or your legal guardian or agent).4State of Texas. Texas Health and Safety Code 166.083 – Form of Out-of-Hospital DNR Order You cannot complete this one on your own. Schedule an appointment, bring the standardized form from the Texas HHS website, and sign it together.
The order instructs EMS personnel not to initiate CPR, advanced airway management, artificial ventilation, defibrillation, or other resuscitation measures. It applies in any setting outside a hospital, including your home, a nursing facility, or during transport, and the statute requires the form to accompany you when you are moved.4State of Texas. Texas Health and Safety Code 166.083 – Form of Out-of-Hospital DNR Order
As an alternative to carrying the paper form, Texas law lets you wear an approved OOH-DNR identification device. EMS must honor an intact, unaltered plastic bracelet bearing the word “Texas” and the words “Do Not Resuscitate,” or a metal bracelet or necklace inscribed with “Texas Do Not Resuscitate – OOH.” You pay for these devices yourself.7Cornell Law Institute. 25 Texas Administrative Code 157.25 – Out-of-Hospital Do Not Resuscitate Order
Signing and Witnessing
All three forms must be signed to be legally valid. Texas gives you two options: sign in front of two qualified adult witnesses, or sign and have your signature acknowledged by a notary public. You do not need both.8State of Texas. Texas Health and Safety Code 166.154 – Execution
Who Cannot Serve as the First Witness
Both witnesses must be competent adults. At least one of them cannot be:
- Related to you by blood or marriage
- Your designated healthcare agent
- A person entitled to any part of your estate, by will or by law
- Your attending physician or an employee of your attending physician
- An employee of the healthcare facility providing your direct care, or an officer, director, partner, or business office employee of that facility
- Anyone with an existing claim against your estate
The second witness only needs to be a competent adult, but using two fully independent witnesses removes any future challenge to the document. The easiest approach is to pick two people who have no family or financial connection to you.
Electronic and Digital Signatures
Texas law allows electronic and digital signatures on all three forms. A digital signature must use an algorithm approved by the Texas Health and Human Services Department, be unique to the signer, be verifiable, remain under the signer’s sole control, and be bound to a digital certificate. An electronic signature has similar requirements but does not need the digital certificate. In either case, the signature must persist with the document itself, not in a separate file.10State of Texas. Texas Health and Safety Code 166.011 – Digital or Electronic Signature If you are going this route, have an attorney confirm your method qualifies.1Texas Health and Human Services. Advance Directives
After You Sign
A signed directive that nobody can find during a crisis is the same as no directive at all. Distribute copies to your primary and alternate agents, your primary care physician (ask the office to scan it into your electronic medical record), any hospital where you are admitted, and close family members who should know the document exists and where to find it.
Keep the original somewhere secure but accessible. A fireproof lockbox at home works. A safe deposit box is less useful because your agent may not be able to reach it quickly. If you have an OOH-DNR, put the original where emergency responders will see it immediately. The front of the refrigerator or the back of the main bedroom door are common locations EMS personnel are trained to check.1Texas Health and Human Services. Advance Directives If you travel often, an approved DNR identification bracelet or necklace solves the problem of the paper form being at home while you are not.7Cornell Law Institute. 25 Texas Administrative Code 157.25 – Out-of-Hospital Do Not Resuscitate Order A digital copy on your phone or cloud service is a fine backup, not a substitute.
Changing or Revoking a Directive
You can revoke a Directive to Physicians at any time, regardless of your mental state. Texas provides three methods:
- Destroy the document. You, or someone acting at your direction, can cancel, deface, tear, burn, or otherwise destroy the original.
- Write a signed, dated revocation. It takes effect only when you or someone on your behalf notifies your attending physician or mails the revocation to them.
- Revoke orally. This takes effect only when communicated to your attending physician, who must record the time, date, and place and mark “VOID” on each page of the directive in your medical record.
Revoking an OOH-DNR works similarly and also allows a legal guardian, qualifying relative, or healthcare agent to revoke it. Destroy the form and remove any DNR identification device, or orally communicate the revocation to the responding EMS professionals or your attending physician.12State of Texas. Texas Health and Safety Code 166.092 – Revocation of Out-of-Hospital DNR Order
Whenever you revoke, notify everyone who received a copy. A hospital working from an outdated photocopy has no way to know you changed your mind unless you tell them. For changes rather than a full revocation, the cleanest approach is to revoke the old document, execute a new one, and redistribute it.
If You Spend Time in Another State
Advance directive laws vary significantly from state to state, and there is no federal rule requiring one state to honor another state’s form. Many will, but medical staff unfamiliar with the Texas form may hesitate before following it. If you regularly spend extended time in another state, execute a separate directive there using that state’s statutory form, and keep the Texas documents with you as a backup.