This form lets you name a health care agent to make medical decisions for you if you cannot make or communicate them yourself. It follows Arizona’s sample form and includes optional choices about autopsy, organ donation and funeral arrangements. It does not cover money; for that, use a Durable Power of Attorney. This form lets you name a health care agent to make medical decisions for you if you cannot make or communicate them yourself.
Serving Arizona. Appointments require an Arizona-commissioned notary.
This form lets you name a health care agent to make medical decisions for you if you cannot make or communicate them yourself. It follows Arizona’s sample form and includes optional choices about autopsy, organ donation and funeral arrangements. It does not cover money; for that, use a Durable Power of Attorney.
What you'll need
The original Health Care Power of Attorney - Arizona packet and its instructions.
Names, dates and supporting records identified in this packet.
Acceptable identification for any notarial act; arrange qualified witnesses when required.
How to complete it
Name your agent and a successor (Part 1) Your agent should know your wishes and be willing to serve.
Initial your choices Living will attached or not, autopsy and organ donation are optional.
Add instructions (Parts 4–5, optional) Funeral wishes, limits or religious preferences.
Sign before a notary or one qualified witness Use one or the other. We recommend a notary: it avoids witness disqualification problems and is widely accepted.
This form lets you name someone (your “agent”) to handle your financial and legal affairs, such as banking, real estate, taxes and benefits. In Arizona, a power of attorney continues after incapacity only if it says so; this form includes the required wording. It does not cover medical decisions; for those, use an Arizona Health Care Power of Attorney.
This form lets doctors, hospitals and health plans share your medical information with family members or others you choose. It does not let them make decisions for you; for that, use a Health Care Power of Attorney.
A living will tells your doctors and your health care agent which life-sustaining treatments you do or do not want if you have a terminal condition or are in an irreversible coma or persistent vegetative state. It follows Arizona’s sample form.
This form lets you name an agent to make mental health treatment decisions for you if you are found incapable, and lets you write which treatments you do and do not want. It follows Arizona’s sample form.
Use this form to cancel all or part of a health care power of attorney, living will or mental health care power of attorney. A written, notarized revocation leaves a clear record for hospitals and family.
These forms are a free convenience, not legal advice. First Choice Mobile Notary & Apostille is not a law firm. Consult an attorney licensed in the relevant state for legal questions.