Texas Advance Directive: Two Forms and the Notary Rule

Texas splits it into two documents with confusingly similar names — and most families fill out one, think they’re done, and have left the more important half undone.

The Texas advance directive is really two separate instruments under the Texas Advance Directives Act, Health & Safety Code Chapter 166: the Directive to Physicians and Family or Surrogates (the living will) and the Medical Power of Attorney (which names your decision-maker). You want both, and the Medical Power of Attorney is the one people skip.

This page covers each document, where to get the current official versions, how Texas wants them signed — including a rule that changed recently — and the Texas-specific features that set these forms apart.

Texas, in short

Two documents. Directive to Physicians (what she wants) and Medical Power of Attorney (who decides). Do both.
Governed by Chapter 166 — the Texas Advance Directives Act.
Two witnesses OR a notary. Texas now allows notarization as an alternative to witnesses on these documents.
The witness rules are strict — at least one witness must clear a long disqualification list.
The Directive offers three explicit choices, including letting your agent decide.
A separate Out-of-Hospital DNR is what actually stops CPR at home.

The two Texas documents

The Directive to Physicians and Family or Surrogates (§§ 166.031–166.033) is Texas’s living will. It records what she wants if she has a terminal or irreversible condition and can no longer decide for herself. Texas’s version is unusually clear, because it makes her choose explicitly among three options — more on that below.

The Medical Power of Attorney (§§ 166.151–166.164) names a health care agent to make medical decisions when a physician certifies she can’t. It covers all health care decisions, not only end-of-life ones, which makes it the broader and more useful document. It is also the one families most often leave undone.

You want both, because they solve different problems: the Directive states her wishes, the Medical Power of Attorney appoints a person who can respond to everything the Directive didn’t anticipate. Why the agent usually matters more than the living will →

Where to get the official Texas forms

Use current official versions. Reliable, free sources:

Texas Health and Human Services publishes all the advance directive forms — Directive to Physicians, Medical Power of Attorney, and Out-of-Hospital DNR — at hhs.texas.gov, in English and Spanish.
The Texas Medical Association provides the forms with explanatory notes.
Texas hospitals keep them on hand and are required to offer information about them.

The statutory forms are built into Chapter 166, but you are not required to use them — Texas law is explicit that no particular form is mandatory. Using the official form is nonetheless the safer choice, especially because the Medical Power of Attorney must include a specific disclosure statement, and the statutory form already contains it.

If you can’t locate the forms, the Eldercare Locator (1-800-677-1116) connects you to the Area Agency on Aging for her county.

How Texas wants them signed — the rule that changed

For years, Texas required two witnesses. That has changed. Texas now allows a person’s signature to be acknowledged before a notary public as an alternative to witness signatures on the Directive to Physicians, the Medical Power of Attorney, and the Out-of-Hospital DNR. Either route — two qualifying witnesses, or a notary — now works. You do not need both.

If she uses witnesses, Texas’s rules under § 166.003 are among the strictest in the country. At least one of the two witnesses must not be any of the following:

The person she named as her agent.
A person related to her by blood or marriage.
A person entitled to any part of her estate, or who has a claim against it.
Her attending physician, or the physician’s employee.
An employee of the health care facility where she’s a patient, if that employee provides her direct care or is an officer or business-office employee of the facility.

The clean way to handle it in Texas

Two simple routes avoid every pitfall. Either use a notary — now expressly allowed, and it removes all the witness-qualification complexity — or use two disinterested people where at least one is unrelated to her, isn’t in her will, isn’t her agent, and isn’t connected to her doctor or care facility. Given how long the disqualification list is, many Texas families find the notary the simpler path.

The Directive’s three choices

One genuinely good feature of the Texas Directive to Physicians: rather than leaving you to compose instructions from scratch, it presents three explicit options for a terminal or irreversible condition. She picks one:

Direct that life-sustaining treatment be withheld or withdrawn, allowing a natural death.
Direct that life-sustaining treatment be provided, to prolong life as far as possible.
Let her agent decide, based on her known wishes and values.

That third option is why the two documents work best together — it explicitly hands the judgment to the person named in the Medical Power of Attorney, precisely because no form can anticipate every situation.

Two more Texas specifics

The agent’s authority begins on a physician’s certification. Under the Texas Medical Power of Attorney, the agent can act only once the attending physician certifies in writing that she lacks the capacity to make her own decisions. Until then, she decides for herself — and even after, her expressed wishes in the moment override the directive (§ 166.037).

Out-of-state directives are recognized. Under § 166.005, a directive validly executed in another state is enforceable in Texas. As always, an unfamiliar out-of-state form can slow things at a hospital desk, so completing Texas’s own forms is worthwhile if she’s now a Texan.

What stops CPR at home: the Out-of-Hospital DNR

Neither the Directive nor the Medical Power of Attorney will stop paramedics from performing CPR. Texas handles that with a distinct document — the Out-of-Hospital DNR (§§ 166.081–166.082), a standardized order signed by the patient (or agent) and the attending physician, directing EMS to withhold resuscitation. It’s available as an order, and Texas also offers a DNR device such as a bracelet or necklace. It’s for people who are seriously ill, and it’s arranged through her doctor. More on why a directive alone won’t stop CPR →

And as everywhere, none of these cover money — that needs a separate durable financial power of attorney. What a financial power of attorney is, and the word that decides whether it works →

After she signs

Give the agent and any alternate a copy of the Medical Power of Attorney.
Give copies to her physician and any hospital or facility involved in her care.
Keep the originals somewhere accessible at home, not locked away — and photograph them.
Take copies to any hospital admission.

The directive settles who decides. This settles what she needs now.

Getting the documents done is one half of an aging-at-home plan. The other is knowing how much day-to-day help she actually needs — and “she’s slowing down” isn’t something a doctor or an agency can act on.

The care needs checklist walks the same fourteen questions a visiting nurse walks and ends with something specific: which daily tasks need hands-on help, roughly how many hours a week, and which gaps are genuine safety issues.

Take the care needs checklist →

Free. No email, nothing stored — it runs in your browser and the answers never reach me.

Where to go next

The full how-to, including the witnessing mistakes that void a document: how to fill out an advance directive →

The financial side is separate: what a power of attorney is →

If she won’t discuss any of it: when an aging parent refuses help →

Questions families ask

What is the Texas advance directive called?

Texas uses two separate documents under Health and Safety Code Chapter 166 rather than one combined form: the Directive to Physicians and Family or Surrogates, which is the living will, and the Medical Power of Attorney, which names a health care agent. The Directive records treatment wishes for a terminal or irreversible condition, while the Medical Power of Attorney appoints someone to decide across all medical care. Most people should complete both.

Does a Texas advance directive need to be notarized?

Not necessarily — Texas now allows either two qualifying witnesses or a notary acknowledgment on the Directive to Physicians, the Medical Power of Attorney, and the Out-of-Hospital DNR. This is a recent change from the previous witness-only requirement, and either route alone is sufficient. Many families find the notary route simpler because it avoids Texas’s detailed witness-disqualification rules.

Who can witness a Texas advance directive?

If witnesses are used, two are required, and at least one must not be the named agent, a relative by blood or marriage, a person entitled to part of the estate, the attending physician or the physician’s employee, or a facility employee providing direct care. These disqualifications come from Health and Safety Code Section 166.003 and are among the strictest in the country. Using a notary instead avoids the witness-qualification complexity entirely.

What is the difference between a Directive to Physicians and a Medical Power of Attorney in Texas?

The Directive to Physicians is Texas’s living will and records what treatment a person wants if they have a terminal or irreversible condition, speaking directly to doctors. The Medical Power of Attorney names an agent to make health care decisions once a physician certifies the person cannot decide, and it covers all medical care rather than only end-of-life situations. They serve different functions, and having both is recommended.

When does a Texas medical power of attorney take effect?

A Texas Medical Power of Attorney takes effect only when the attending physician certifies in writing that the person lacks the capacity to make their own health care decisions. Until that certification, the person continues to make their own decisions, and even afterward their expressed wishes in the moment override the document. This means naming a trusted agent does not surrender any control while the person remains capable.

Where do I get the official Texas advance directive forms?

Texas Health and Human Services publishes all the forms — the Directive to Physicians, Medical Power of Attorney, and Out-of-Hospital DNR — at hhs.texas.gov in English and Spanish, and the Texas Medical Association provides them with explanatory notes. Texas hospitals also keep them on hand. The statutory forms are not mandatory, but using the official Medical Power of Attorney is wise because it contains a required disclosure statement.

Does a Texas advance directive stop CPR at home?

No — neither the Directive to Physicians nor the Medical Power of Attorney stops paramedics from performing CPR. Texas uses a separate Out-of-Hospital DNR order under Sections 166.081 and 166.082, signed by the patient or agent and the attending physician, to direct emergency personnel to withhold resuscitation. It is intended for people who are seriously ill and is arranged through the treating doctor, and Texas also offers a DNR bracelet or necklace.

Changelog

26 July 2026 — Published. Two-document structure, the notary-alternative execution rule, witness disqualifications, the three-option directive, and the Out-of-Hospital DNR verified against Texas Health & Safety Code Chapter 166, §§ 166.003, 166.032–166.033, 166.151–166.164, and 166.081–166.082.

This page is reviewed every six months, and immediately if Texas law changes. When it changes, this list will say so.

Sources

Texas Health & Safety Code Chapter 166 (Texas Advance Directives Act) — including § 166.003 (witnesses), §§ 166.031–166.033 (Directive to Physicians), §§ 166.151–166.164 (Medical Power of Attorney), § 166.005 (out-of-state directives), and §§ 166.081–166.082 (Out-of-Hospital DNR)
Texas Health and Human Services — official advance directive forms and the notary-acknowledgment option
Texas Medical Association — Directive to Physicians and Medical Power of Attorney forms and guidance
Thirteen years of the author’s own observation inside home health and hospice referral, labeled as such throughout

Last verified: 26 July 2026 against Texas Health & Safety Code Chapter 166 · Next review: January 2027, or immediately on a relevant change in Texas law

Written by Mark Duda. Thirteen years running business development for one of New Jersey’s largest home health and hospice organizations, including the nurse liaisons who arranged care at the bedside before patients went home. More about me → · How this page was checked →

This page is educational and is not legal advice. Mark Duda is not an attorney. It describes Texas law as of the date shown and may not reflect later changes. Advance directive requirements are exacting and the consequences of an execution error are serious — confirm the current forms and rules with the official Texas source, and consult an attorney licensed in Texas if anything is unclear. See our disclaimers.