Appendix IV, Disclosure Statement for Medical Power of Attorney

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Revision 05-1; Effective December 2, 2005

Disclosure Statement for Medical Power of Attorney:

https://hhs.texas.gov/laws-regulations/forms/miscellaneous/mpoa-medical-power-attorney

Visit the web site below for additional information:

https://hhs.texas.gov/laws-regulations/forms/advance-directives