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Patients & Visitors
Other Medical Forms
We Can Help.
Advance Directives
An Advance Directive or Living Will is designed to help you communicate your wishes about medical treatment at some time in the future when you are unable to make your wishes known because of illness or injury.
The State of Texas recognizes four types of Advance Directives:
- Medical Power of Attorney
- Directive to Physicians and Family or Surrogates
- Out-of-Hospital Do-Not Resuscitate (DNR) Order
- Declaration for Mental Health Treatment
You are not required to complete any of these Advance Directives - this is your personal choice.
This information is provided to comply with the State Advance Directives Act and the federal Patient Self-Determination Act. Complaints concerning failure by a hospital, nursing home or home health agency to follow federal and state advance directive requirements may be filed with the Texas Department of Health, Health Facility Compliance Division, 1100 West 49th Street, Austin, Texas 78756 (1-800-228-1570). You are not required to complete these forms as part of patient registration in a hospital, nursing home or home health care agency, or at any time in the future should you choose not to do so.
Medical Power of Attorney
A Medical Power of Attorney gives the person you name as your agent the authority to make any and all health care decisions for you in accordance with your wishes, including your religious and moral beliefs, when you are no longer capable of making them yourself
Download Medical Power of Attorney form in PDF format
Directive to Physicians and Family or Surrogates
A Directive to Physicians and Family or Surrogates is designed to help you communicate your wishes about medical treatment at some time in the future when you are unable to make your wishes known because of illness or injury. It allows you to instruct physicians to administer, withdraw or withhold life-sustaining treatment when it has been determined by your physician that you have an irreversible or terminal condition and you are not able to communicate your wishes.
Download Directive to Physicians and Family or Surrogates form in PDF format
Out-of-Hospital Do-Not-Resuscitate (DNR) Order
An Out-of-Hospital DNR Order form or ID necklace or bracelet tells health care providers, including emergency medical service personnel, not to use cardiopulmonary resuscitation (CPR) and other life-sustaining treatments.
Download Out-of-Hospital Do-Not Resuscitate (DNR) Order form in PDF format
Declaration for Mental Health Treatment
The Declaration for Mental Health Treatment is a document that indicates the kinds of mental health services you do or do not agree to (including such options as psychoactive medications, convulsive treatment and preferences for emergency treatment such as restraint, seclusion, or medication).
Download Declaration for Mental Health Treatment form in PDF format
Things to remember when executing any or all Advance Directives:
- It is always best to get legal professional advice before signing any advanced directive. You should also discuss these documents with your family, physician, clergy, friends, etc.
- Keep a copy of all Advance Directives in a safe place.
- Make sure that your family members are aware of your wishes.
- Give a copy of all Advance Directives to your primary care physician.
- Keep a personal record of everybody that has a copy of your Advance Directives and other important personal papers.
- You can change or cancel an advance directive at any time.
- Nobody can force you to have an Advance Directive.
- If you do not have an Advance Directive, family members and your attending physician may be able to make decisions about your care if you are unable to do so.
- If you have questions about Advance Directives, consult with your doctor, clergy, attorney and/or family members.
If you have an advance directive and you believe it is being ignored, please contact the administrator on duty for access to the facility's ethics committee as applicable. You may also contact the Texas Department of Health, Health Facility Compliance Division, 1100 West 49th Street, Austin, TX 78756 (1-800-2281570) regarding your concerns.
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