How to Fill Out Texas Directive to Physicians and Family or Surrogates + FAQs

The Texas Directive to Physicians and Family or Surrogates is a written legal document that lets a competent adult tell doctors and loved ones whether to use, withhold, or withdraw life-sustaining treatment if a physician later certifies that person has a terminal or irreversible condition. The form is created and protected by Chapter 166 of the Texas Health and Safety Code, and the statutory model language lives in Section 166.033.

Filling it out wrong, or skipping the witness rules, can leave your wishes unenforceable at the worst possible moment. According to a 2023 Health Affairs review of advance directives, only about 36.7% of U.S. adults have completed any form of advance directive, and rejection or confusion at the bedside is most often caused by witness errors and missing initials. Here is what you will learn:

• 📋 Exactly what each line, box, and signature block on the Texas Directive means in plain English
• ✍️ How to choose between the “terminal condition” and “irreversible condition” sections without canceling your own wishes
• 👥 Who can legally witness your signature and who is banned by statute from witnessing it
• 🏥 How to get the signed directive into your medical record, MyChart, and the right hands at the hospital
• ❓ Field-level FAQs covering pregnancy limits, revocation, out-of-state portability, and surrogate appointment

What the Form Is and Who Must File It

The Texas Directive to Physicians and Family or Surrogates is the state’s statutory “living will.” It is the document Texas law recognizes when a patient can no longer speak and a doctor must decide whether to keep using a ventilator, feeding tube, dialysis, CPR, or other life-sustaining treatment. The form is authorized by the Texas Advance Directives Act, which the Legislature passed in 1999 to combine three older laws into one chapter.

Any competent adult who is 18 or older, or a younger person who is or has been married or who has had the disabilities of minority removed, may sign the directive. The Texas Health and Human Services Commission publishes a plain-language version of the form, and the Texas Medical Association hosts a clean PDF that mirrors the statutory language. You do not “file” this form with a court or agency. Instead, you sign it, have it witnessed or notarized, and deliver copies to your doctors, hospital, and family.

People most likely to need this form include patients newly diagnosed with cancer, ALS, dementia, or end-stage organ disease, adults doing estate planning alongside a will and power of attorney, and caregivers helping aging parents prepare before capacity slips. Hospitals are required by the federal Patient Self-Determination Act to ask every adult on admission whether they have an advance directive, which is why having one already signed avoids a stressful bedside conversation.

Before You Start: Documents and Information You Need

Gather everything below before you sit down with the form. Missing one item is the most common reason people stop halfway and never come back to finish.

• Government-issued photo ID. You need this if you sign in front of a notary, because the notary must verify identity under Texas Government Code §406.016. Without it, the notarization fails.
• Full legal name as it appears on your driver’s license or passport. Mismatched names between the directive and your hospital chart cause record-matching errors.
• Date of birth in MM/DD/YYYY format. Hospitals index records by DOB, and an inconsistent format can cause the directive to be filed under a different patient.
• Two qualified witnesses or one notary public. You need to identify them before signing, because the form requires their information at the moment of execution.
• Name, address, and phone of any agent or surrogate you wish to designate. The directive lets you name a spokesperson, and incomplete contact info means the hospital cannot reach them.
• Names and contact info for your attending physician and primary hospital. You will deliver a copy to each, and you should know who to send it to.
• A list of specific treatments you want addressed. Examples include CPR, mechanical ventilation, artificial nutrition and hydration, dialysis, and antibiotics. The form has an optional “additional requests” area where you can list these.
• Any religious or cultural preferences in writing. The Texas Conference of Catholic Bishops and other faith bodies publish guidance you may want to attach as an addendum.
• Existing Medical Power of Attorney, if any. The directive and the Medical Power of Attorney work together, so you should have both consistent.
• A reliable copy method. Plan to make at least four copies — one for your doctor, one for your hospital, one for your agent, and one for your records.

Where to Get the Form and How to Access It

The official statutory form sits inside Texas Health and Safety Code §166.033, and any directive that “substantially complies” with that language is valid. The cleanest downloadable PDF comes from the HHSC Advance Directives page, which maintains the current revision and English/Spanish versions.

You can also obtain the form free of charge from the Texas Medical Association sample directive, most Texas hospital admissions desks, and many county law libraries. Hospitals are required to provide it on request under federal law. Estate-planning attorneys and online legal services such as Texas Law Help also distribute the same statutory text, sometimes wrapped in extra instructions.

The form is free. There is no filing fee, no court cost, and no agency charge to execute it. Be wary of websites that try to charge for the “official Texas living will” — the statutory form is in the public domain and reproducible by anyone, as confirmed by the Texas Attorney General’s consumer protection guidance.

You may complete it on paper or electronically. Texas accepts directives signed with a wet-ink signature in front of two witnesses, and under Section 166.011 digital signing in front of a remote online notary is permitted. If you choose remote online notarization, the notary must be commissioned in Texas and use an approved RON platform listed by the Secretary of State.

Step-by-Step: How to Fill Out the Texas Directive Line by Line

Work through the directive in the exact order it appears on the statutory form. Each subsection below maps to one labeled section, paragraph, or signature block of the official document.

Section 1: Heading and Date of Document

The top of the form contains the title “Directive to Physicians and Family or Surrogates” and a blank line for the date you sign.

You write the calendar date you actually sign in MM/DD/YYYY format. Do not pre-date or post-date the form. Maria Lopez writes 03/14/2026 in the date line at the top.

A common edge case is signing across midnight — if your witnesses are present after 11:30 p.m. and the clock rolls over, use the date the last signature is applied, because the directive is not effective until fully witnessed.

The most common mistake here is leaving the date blank, which lets a future court argue the directive predates a later mental incapacity, undermining its weight. A frequent misconception is that the date is just paperwork; in fact, the date establishes which version controls when multiple directives exist, since Section 166.042 treats the most recent valid directive as the operative one.

Section 2: Declarant Identification

The opening paragraph reads, “I, ______, recognize that the best health care is based upon a partnership of trust and communication with my physician.”

You print your full legal name in block letters exactly as it appears on your government ID. Avoid nicknames, initials, and maiden-name shortcuts. David Allen Reyes writes DAVID ALLEN REYES in the name blank.

If you go by a different name in daily life — say, a married name not yet on your ID — list the legal name first and add “(also known as Jane Smith)” in parentheses. This prevents identity mismatches at the hospital.

A frequent mistake is signing with a nickname like “Dave” while the rest of your records show “David Allen Reyes,” because chart-matching software may flag the directive as belonging to a different patient. The misconception is that the name “doesn’t matter as long as I sign” — Texas chart auditors routinely reject directives where the printed name and signature do not align.

Section 3: Terminal Condition Paragraph

This paragraph states that if you have a terminal condition, you direct that life-sustaining treatment be provided only to keep you comfortable, or be withheld or withdrawn, and you be permitted to die naturally.

You either initial or sign next to this paragraph to adopt it. Do not cross it out unless you intend to reject it entirely. Eleanor Briggs initials EB next to the terminal-condition paragraph.

The edge case here is the legal definition of “terminal condition,” which under Section 166.002(13) means an incurable condition expected to cause death within six months even with available treatment. If you want a stricter or looser standard, write it into the additional-instructions section below.

The most common mistake is initialing both this paragraph and the irreversible-condition paragraph in contradictory ways without realizing they apply to different medical states. The misconception is that “terminal” means “old” or “very sick”; it has a specific clinical meaning tied to a six-month prognosis.

Section 4: Irreversible Condition Paragraph

This paragraph addresses an irreversible condition such as advanced dementia or a persistent vegetative state, where you cannot care for yourself or recognize family but death is not imminent.

You initial this paragraph if you want life-sustaining treatment withheld or withdrawn in that state. You may also choose to request treatment by writing “I want all treatment” in the optional space. David initials DR next to the irreversible-condition paragraph because he does not want a feeding tube if he reaches advanced Alzheimer’s.

The nuance is that “irreversible” under Section 166.002(9) means a condition that cannot be cured and will result in death without life-sustaining treatment. Patients with stroke or traumatic brain injury sometimes qualify even though they could live for years on a ventilator.

A common mistake is leaving this paragraph blank, which creates ambiguity that may push the medical team to default to full treatment. The misconception is that “irreversible” and “terminal” are synonyms — they are not, and Texas treats them as two distinct legal categories.

Section 5: Additional Requests

The form provides blank lines labeled “Additional requests” where you can list specific treatments you want or refuse.

You list each treatment with a clear yes or no — for example, “I do not want CPR,” “I do not want mechanical ventilation longer than 14 days,” or “I want artificial nutrition and hydration.” Maria writes I do not want CPR, intubation, or dialysis. I want comfort care and pain medication.

The edge case worth thinking through is partial-treatment scenarios such as time-limited trials of a ventilator. You can write, “I consent to a 7-day ventilator trial; if no improvement, withdraw.”

A common mistake is leaving this section blank and assuming the boilerplate covers everything, which forces your family to guess about feeding tubes, antibiotics, and hospice transfers. The misconception is that adding instructions weakens the form; in reality, the Texas Hospital Association reports that specific instructions reduce family disputes and ICU length of stay.

Section 6: Designation of Spokesperson (Surrogate)

The form lets you name a person to make treatment decisions consistent with your directive if you cannot speak.

You print the full name, relationship, address, and daytime phone of your chosen spokesperson. Eleanor names her daughter, Sarah Briggs, 1422 Pecan St., Austin, TX 78704, (512) 555-0142.

The nuance is that this spokesperson under the directive is not the same as a Medical Power of Attorney agent under Section 166.164. The directive surrogate has narrower authority limited to enforcing this document, while an MPOA agent can make broader medical decisions.

A common mistake is naming a spouse who is also a witness, which creates a conflict and may invalidate the witness signature. The misconception is that naming a surrogate here replaces the need for a Medical Power of Attorney; you typically want both.

Section 7: Declarant Signature

The signature block requires you to sign in front of two qualified witnesses or before a notary public.

You sign your name in cursive exactly as you signed your driver’s license, then print the date and city. David signs David A. Reyes, dates 04/02/2026, and writes Houston, Texas.

If a physical disability prevents signing, another adult may sign in your presence and at your direction, as permitted by Section 166.032(b). That proxy must also print and date their action.

A common mistake is signing before the witnesses arrive, which violates the contemporaneous-signing requirement and voids the directive. The misconception is that a signature alone, without the rest of the witness or notary block, is enough — it is not.

Section 8: Witness 1 Signature and Address

Witness 1 must meet strict eligibility rules under Section 166.003 and cannot be related to you, an heir, your attending physician, an employee of your physician, an officer or employee of a health care facility where you are a patient, or a person with a claim against your estate.

Witness 1 prints their full name, address, and signs. Carlos Mendez, 88 Lavaca St., Austin, TX 78701, signs as Witness 1.

The edge case is hospital staff: a chaplain who is not employed by the hospital can serve, but a staff nurse cannot, even if friendly. Always confirm employment status before asking someone to witness.

A common mistake is using a neighbor who happens to be in your will, because being entitled to any portion of your estate disqualifies them. The misconception is that “witness” just means “someone who saw you sign”; in Texas, it is a tightly regulated legal role.

Section 9: Witness 2 Signature and Address

Witness 2 has additional restrictions beyond Witness 1. Under Section 166.003(2), Witness 2 cannot be the designated spokesperson, related by blood or marriage, entitled to any part of the estate, the attending physician or their employee, or an officer or employee of a health care facility involved in your care.

Witness 2 prints their full name, address, and signs in your presence. Aisha Johnson, 412 Travis St., Austin, TX 78701, signs as Witness 2.

The nuance is that Witness 2’s stricter requirements exist precisely to prevent undue influence — Texas wants at least one truly independent witness. A coworker with no inheritance interest is the safest choice.

A common mistake is using a family member as Witness 2, which is the single most frequent reason directives are rejected by hospital ethics committees. The misconception is that the two witnesses have identical rules; only Witness 2 must be free of family and inheritance ties.

Section 10: Notary Acknowledgment (Alternative to Witnesses)

Instead of two witnesses, you may sign in front of a Texas notary public. The notary completes a jurat acknowledging your signature.

The notary verifies your ID, watches you sign, then completes the notarial certificate with their commission number, expiration date, seal, and signature. Notary Linda Park, Commission #131992345, expires 09/30/2027, applies her seal beneath the acknowledgment.

The edge case is remote online notarization. Texas allows RON under Government Code Chapter 406, Subchapter C, and the audio-video recording must be retained for five years.

A common mistake is using an out-of-state notary, which Texas hospitals will reject. The misconception is that a notary “trumps” the witness rules and lets you skip every other formality; the notary replaces the witnesses but does not waive any other requirement.

Three Filled-Out Examples Using Real Scenarios

Scenario A: Maria Lopez, 68, Stage IV Pancreatic Cancer

Form Section	What Maria Enters
Date at top	03/14/2026
Full legal name	MARIA ELENA LOPEZ
Terminal condition paragraph	Initials MEL
Irreversible condition paragraph	Initials MEL
Additional requests	No CPR, no intubation, no dialysis. Comfort care and morphine as needed. Hospice transfer preferred.
Designated spokesperson	Son, Javier Lopez, 9210 Westheimer, Houston, TX 77063, (713) 555-0199
Signature line	Maria E. Lopez, 03/14/2026, Houston, Texas
Witness 1	Father Daniel Ruiz, parish priest, 600 Lovett Blvd, Houston
Witness 2	Coworker Anita Patel, 14 Main St., Houston (no inheritance, unrelated)

Scenario B: David Reyes, 45, Healthy Estate Planning

Form Section	What David Enters
Date at top	04/02/2026
Full legal name	DAVID ALLEN REYES
Terminal condition paragraph	Initials DAR
Irreversible condition paragraph	Initials DAR with note no feeding tube if advanced dementia
Additional requests	Time-limited 14-day ventilator trial acceptable. No long-term artificial nutrition.
Designated spokesperson	Wife, Karen Reyes, 1187 Heights Blvd, Houston, TX 77008, (832) 555-0143
Signature line	David A. Reyes, 04/02/2026, Houston, Texas
Witness 1	Neighbor Tom Walker, 1189 Heights Blvd (not in will, unrelated)
Witness 2	Notary Linda Park used in lieu of second witness

Scenario C: Eleanor Briggs, 80, Early Alzheimer’s

Form Section	What Eleanor Enters
Date at top	05/19/2026
Full legal name	ELEANOR MAY BRIGGS
Terminal condition paragraph	Initials EMB
Irreversible condition paragraph	Initials EMB
Additional requests	No CPR. No feeding tube. Antibiotics only for comfort. DNR order to be entered.
Designated spokesperson	Daughter, Sarah Briggs, 1422 Pecan St., Austin, TX 78704, (512) 555-0142
Signature line	Eleanor M. Briggs, 05/19/2026, Austin, Texas
Witness 1	Pastor Greg Hill, First Methodist Austin
Witness 2	Friend Lillian Wong, 88 Cedar Ln., Austin (unrelated, no inheritance)

How to File the Completed Form

Texas does not require you to file the directive with a court or state agency, but you must distribute it so it is available when needed. Treat distribution as the actual “filing” step.

Deliver a signed original or a clear photocopy to your attending physician’s office, who must place it in your medical record under Section 166.034. Most major systems — including MD Anderson, Houston Methodist, and Baylor Scott & White — let you upload the directive to the patient portal as a PDF, often through MyChart.

For hospitals, hand a copy to the admissions desk on every visit and ask them to scan it into your chart. The federal Patient Self-Determination Act requires Medicare- and Medicaid-participating hospitals to ask about and document advance directives at admission.

You may also register the directive with the Texas Health Care Information Collection living will registry where available, or use a private service such as U.S. Living Will Registry. Registration is optional, but it lets emergency departments retrieve the document electronically. There is no fee for the statutory directive itself, no payment method to worry about, and processing time is immediate once delivered. Keep your stamped copy or portal upload confirmation as proof of filing.

What Happens After You File

Once your physician receives the directive, it becomes part of your permanent medical record and travels with you across most Texas hospital systems through the Texas Health Services Authority HIE. Your doctor reviews it at your next appointment and may ask follow-up questions to confirm understanding.

The directive sits dormant until a physician certifies in writing that you have a terminal or irreversible condition and that you cannot communicate. At that point, the medical team consults the directive, your spokesperson, and any Medical Power of Attorney agent before withholding or withdrawing treatment under Section 166.039.

If a physician objects on conscience grounds, the law requires a transfer attempt to another willing provider, and the Texas Advance Directives Act §166.046 review process governs disputes. This is the controversial “10-day rule” that has been litigated repeatedly, including in the Tinslee Lewis case covered by Texas appellate courts.

Your directive remains valid until you revoke it. Unlike some states, Texas directives have no expiration date, but reviewing every five years and after major life events is best practice.

Mistakes to Avoid When Filling Out the Form

• Leaving the date blank. Without a date, courts cannot tell which directive controls if you have signed more than one over the years.
• Using a family member as Witness 2. Texas explicitly disqualifies relatives by blood or marriage from serving as the second witness, voiding the directive.
• Naming an heir as a witness. Anyone entitled to part of your estate is barred from witnessing, and using one invalidates the signature.
• Letting your attending physician or their employee witness. Hospital staff in your care chain are barred under Section 166.003.
• Signing before the witnesses arrive. All three signatures must occur in each other’s presence; otherwise the directive is invalid.
• Leaving both the terminal and irreversible condition paragraphs blank. A blank form is treated as no preference, defaulting to full treatment.
• Confusing the directive with a Medical Power of Attorney. They are different forms with different agents, and you usually want both.
• Using nicknames in the name field. Mismatched names cause chart-matching errors that can hide the directive when it is needed most.
• Forgetting to give a copy to your spokesperson. A directive that no one can find is the same as no directive.
• Failing to update after a divorce. A former spouse named as spokesperson may still appear authoritative unless you revoke and resign.
• Skipping the pregnancy clause discussion. Under Section 166.049, Texas does not honor directives to withhold treatment from a pregnant patient, and many filers do not realize this.
• Using an out-of-state notary. Hospitals will reject a directive notarized by a notary not commissioned in Texas.

Do’s and Don’ts

Do’s

• Do print clearly in black ink so the document scans cleanly into electronic medical records.
• Do sign in front of both witnesses or a Texas notary on the same day to satisfy the contemporaneous-execution requirement.
• Do give copies to your physician, hospital, spokesperson, and a trusted family member because access matters more than filing.
• Do pair the directive with a Medical Power of Attorney and a Declaration for Mental Health Treatment for full coverage.
• Do revisit the directive after any major diagnosis, divorce, or move so it reflects current wishes.
• Do tell your spokesperson the document exists and where to find the original, since hidden directives are often missed in emergencies.

Don’ts

• Don’t pay for the form — the statutory text is free at HHSC.
• Don’t use a witness who could inherit from you, because inheritance disqualifies them under statute.
• Don’t initial both the “yes treatment” and “no treatment” options if your form offers them, because contradictions confuse the medical team.
• Don’t store the only copy in a safe deposit box your family cannot access during banking hours, since emergencies do not wait for the bank to open.
• Don’t assume out-of-state directives always work in Texas; while Section 166.005 honors directives valid where executed, hospitals may still ask for a Texas form.
• Don’t forget to revoke an older directive in writing if the new one changes your spokesperson, because Section 166.042 treats inconsistent directives based on date.

Pros and Cons of Filing on Your Own vs. With Help

Pros of filing on your own

• Cost is zero, since the form is published free by the State of Texas.
• Speed is fast — most adults can complete the form in 30 minutes.
• You retain complete control over wording and additional requests.
• The statutory form is intentionally written for a 9th-grade reading level so you do not need a lawyer to understand it.
• Online notarization through approved Texas RON platforms makes execution possible from home.

Cons of filing on your own

• You may pick a disqualified witness without realizing it, which is the most common error.
• You may overlook the pregnancy clause, the irreversible-condition definition, or the relationship between this form and a Medical Power of Attorney.
• Without legal review, contradictions between your directive, your will, and your trust can create disputes.
• Self-filers sometimes forget to deliver copies, leaving the directive unenforceable in practice.
• Complex medical wishes, such as time-limited ventilator trials or research-participation preferences, are hard to draft alone.

Filing Channel Quick Compare

Channel	Key Detail
Two witnesses (in person)	Free, immediate, requires both witnesses present at signing
Texas notary public (in person)	Typical fee $6–$25, replaces both witnesses, requires photo ID
Remote online notary (RON)	Done by video, fee $25 and up, recording kept 5 years per Texas SOS rules
Hospital admissions desk	Free scan-in, copy placed in chart at admission
Patient portal (MyChart, etc.)	Free PDF upload, instantly available across linked facilities

Directive vs. Medical Power of Attorney

Feature	Texas Directive vs. MPOA
Purpose	Directive states your treatment wishes; MPOA names an agent to make decisions
Trigger	Directive activates on terminal or irreversible diagnosis; MPOA activates on incapacity
Authority	Directive is narrow (life-sustaining treatment); MPOA covers broad medical decisions
Statute	Directive under §166.033; MPOA under §166.164
Witness rules	Both require two qualified witnesses or a notary, with similar disqualifications

FAQs

Is the Texas Directive to Physicians the same as a living will?

Yes. It is the legal document Texans commonly call a “living will,” authorized by Chapter 166 of the Texas Health and Safety Code, and accepted by every Texas hospital that participates in Medicare or Medicaid.

Do I need a lawyer to fill out the form?

No. The statutory form is designed for self-completion at a 9th-grade reading level, but a lawyer helps when you have complex wishes, blended families, or coordination with a will and trust.

Does the directive expire?

No. Texas directives remain valid until revoked, but reviewing every five years and after any major diagnosis, divorce, move, or family change is best practice.

Can my spouse be one of my witnesses?

No. Witness 2 cannot be related to you by blood or marriage, and using a spouse as a witness invalidates the directive under Section 166.003.

Do I write my full legal name or a nickname in the name field?

Yes, write your full legal name exactly as it appears on your driver’s license or passport, because hospitals match charts by legal name and reject mismatched documents.

What if I am pregnant when the directive would otherwise apply?

No, Texas will not honor a directive to withhold or withdraw life-sustaining treatment from a pregnant patient under Section 166.049, regardless of what the directive says.

Should I initial both the terminal and irreversible condition paragraphs?

Yes, if both reflect your wishes — they cover different medical states, and initialing both ensures coverage whether your condition is terminal or persistent.

Do I need to file the directive in court?

No. You do not file it anywhere. You sign it, witness or notarize it, and deliver copies to your doctor, hospital, spokesperson, and family.

Can I revoke the directive later?

Yes. You may revoke at any time by destroying the document, signing a written revocation, or telling your physician orally, per Section 166.042.

Will my Texas directive be honored in another state?

Yes, most states accept out-of-state directives that were valid where signed, but always check the new state’s law and consider executing a local form.

Can a notary replace both witnesses?

Yes. A Texas notary public’s acknowledgment substitutes for two witnesses, but the notary must be commissioned in Texas and verify your photo ID.

Is the spokesperson on this form the same as a Medical Power of Attorney agent?

No. The directive spokesperson has narrow authority limited to enforcing this document, while a Medical Power of Attorney agent can make broader medical decisions.

Do I need to address feeding tubes specifically?

Yes, if you have a preference. The statutory paragraphs cover “life-sustaining treatment” generally, but writing artificial nutrition and hydration into the additional-requests section removes ambiguity.

Can I use the directive to refuse pain medication?

No. Texas law requires comfort care, including pain management, even when life-sustaining treatment is withheld, so you cannot waive palliative care through this form.