Medical Power of Attorney (Texas)
Client Information
Name of person making this designation
*
Address of person making this designation
*
County of residence
*
Agent:
Name of person appointed as power of attorney
*
Relation to the person designating
*
Address of person appointed as power of attorney
*
Phone of person appointed as power of attorney
*
Format: (000) 000-0000.
First Alternate Agent:
Name of person appointed as power of attorney
*
Relation to the person designating
*
Address of person appointed as power of attorney
*
Phone of person appointed as power of attorney
*
Format: (000) 000-0000.
Address of location that original document will be kept
*
Individuals with signed copies
*
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