Texas Advance Directive Form: Which Documents You Actually Need

Most people searching for a "Texas advance directive form" expect to find a single document. Texas doesn't work that way. The state uses four separate statutory forms: the Directive to Physicians, MPOA, and OOH-DNR under Health and Safety Code Chapter 166, plus the Declaration for Mental Health Treatment under Civil Practice and Remedies Code Chapter 137.

Using the wrong form, or missing one entirely, can leave gaps that surface during the exact emergency you planned for.

The Four Texas Advance Directive Forms

Directive to Physicians and Family or Surrogates (Living Will)

This form communicates your preferences about life-sustaining treatment when you have a terminal condition (expected death within six months even with life-sustaining treatment) or an irreversible condition — an incurable condition that leaves you unable to care for yourself and is fatal without life-sustaining treatment. You can choose to withhold all life-sustaining treatments except comfort care, or request maximum treatment.

The directive stays in effect indefinitely unless you revoke it. You can even issue it verbally in front of two qualified witnesses, though the verbal declaration must be documented in your medical records.

Medical Power of Attorney (MPOA)

The MPOA designates a healthcare agent to make all medical decisions on your behalf once a physician certifies in writing that you lack capacity. Unlike the living will — which only activates for terminal or irreversible conditions — the MPOA covers every healthcare scenario.

Your agent must follow your known wishes, moral values, and religious beliefs. If those wishes aren't documented, they must act in your best interest. The agent cannot consent to voluntary inpatient mental health services, convulsive therapy, psychosurgery, or abortion, or authorize neglect of comfort care.

Out-of-Hospital Do-Not-Resuscitate (OOH-DNR) Order

This form tells EMS personnel and first responders to withhold CPR, transcutaneous cardiac pacing, defibrillation, advanced airway management, and artificial ventilation outside a hospital setting. It applies at home, in nursing facilities, clinics, and public spaces.

The OOH-DNR has strict formatting rules: it must be printed on standard 8.5" x 11" paper, with the clinical order on the front and instructions on the back; separate sheets may still be honored. Both the patient (or surrogate), the attending physician, and witnesses or a notary must sign.

Declaration for Mental Health Treatment (DMHT)

This specialized form covers three specific areas: psychoactive medications, convulsive therapy, and emergency mental health care. Unlike other advance directives, the DMHT automatically expires after three years unless you're incapacitated at that point.

How to Execute Your Texas Advance Directive

You have two options for validating any Texas advance directive:

Option 1: Two witnesses. At least one witness (Witness 1) must be completely disinterested — meaning they cannot be your designated treatment decision-maker, a relative by blood or marriage, a person entitled to any part of your estate, an estate claimant, your attending physician or an employee of that physician, a direct-care facility employee, or a facility officer, director, partner, or business-office employee. Witness 2 can be any competent adult.

Option 2: Notary public. A notary may be used instead of the two-witness option, subject to the form and statutory requirements for the document being executed. This is generally the smoother path, since hospital legal departments are trained to recognize notarized documents without additional verification.

Common Mistakes That Invalidate the Form

The most frequent errors aren't about the medical preferences — they're about execution:

• Using a family member as Witness 1 when they're also a beneficiary of your estate
• Having your designated healthcare agent sign as Witness 1 (Witness 2 may be any competent adult)
• Failing to follow the OOH-DNR's standard 8.5" x 11" front-and-back format (separate sheets may still be honored)
• Skipping the second signature block on the OOH-DNR (Texas requires a "double-signing" acknowledgment)

Where to Get Texas-Specific Forms

The Texas Health and Human Services Commission publishes blank statutory PDFs, but they ship without instructions, witness verification tools, or post-execution guidance. If you want a step-by-step process that covers form selection, witness qualification, and distribution to your medical team, the Texas Advance Directive & Living Will Kit walks through the full execution sequence with validation checklists for each document.

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