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Free Fillable Arizona Medical Power of Attorney Form

Your health is your most critical asset, and hence, you should make all efforts to protect it against all possible emergencies. In Arizona, residents can use the Arizona medical power of attorney (POA) to hedge their health. They can use this instrument to appoint someone to help them with critical decisions affecting their health.

Their trusted agent or attorney-in-fact can make health-related decisions when their principals, also referred to as grantors or donors, can’t make them. For instance, they may suffer a mental disability that requires a mentally healthy person to decide for them. It’s worth noting that Arizona doesn’t provide a special medical power of attorney. It only allows grantors to grant these powers via a durable POA. However, the donor can revise this instrument to cover a particular power of attorney form they need.

Arizona power of attorney templates – get other power of attorney documents for Arizona along with instructions.

Arizona Medical POA Requirements

Arizona has specific provisions governing a medical POA set forth in the local statute (Title 14, Chapter 2, Article 5).. A sane adult donates their power to make medical decisions to an adult by meeting these requirements:

  • The POA must be written in a language that shows clearly that the principal intends to create a medical POA;
  • The POA becomes valid when the donor duly dates, signs, or marks it;
  • A notary public must notarize the POA and witness it in writing before an adult witness who confirms that the notary or the witness saw the donor sign or mark the POA. Moreover, they should witness that the creator is sane and signed it voluntarily;
  • If the principal can’t sign or mark it, the attorney or witness should confirm that the instrument indeed expresses its creator’s wishes and they intended to delegate their medical decision powers;
  • Notaries and witnesses shouldn’t be the principal’s intended agent or medical provider;
  • If the POA has only one witness, they shouldn’t be their blood relatives or related by marriage, or related by adoption. They shouldn’t also the principal’s estate inheritors at the time the POA is executed;
  • Nobody whose fiduciary license is suspended or revoked may act as an agent unless they’re the principal’s blood, adopted, or marital relative.

Filling out the Arizona Medical POA

Filling an Arizona medical POA form is easy. Here’s how to fill it.

Step 1. Open the forms after the principal gathers and organizes any extra paperwork and then save it.

Step 2. Fill the form with all the necessary details as the would-be principal. Fill out your name, address, age, telephone, and date of birth.

Step 3. Identify your chosen agent and supply their contact details. Fill out their name, address, and phone number.

Step 4. Read the third item and then fill out all the necessary details. Write any limitation, restriction, condition, or specification regarding your agent’s authority. This way, you save yourself unnecessary problems arising from ambiguity and abuse of power.

Step 5. You may give your preferences regarding your autopsy. Here, specify if you want your body to undergo an autopsy because the procedure’s voluntary in Arizona. You may indicate the following:

  • You don’t consent to a voluntary autopsy;
  • You consent to a voluntary autopsy;
  • Your agent may consent to or refuse your body to undergo an autopsy.

Step 6. Specify if you want to donate your body organs or not. If you don’t want to donate your body organs, mark the form’s part A. Mark part B if you wish to donate your body organs. If you choose to donate your body parts, fill the form to specify if you donate your entire body, only needed body parts, or specific body parts you wish to donate. Also, specify why you want to donate your body parts and to which organization.

Step 7. Specify how you want your body to be laid to rest. You can either choose cremation or burial. If you opt for a burial, place your initials at the first statement in the form. Opting for cremation requires you to place your initials next to the second statement. Note, your body will be cremated if you opted to donate all of it.

Step 8. Attach your living will to this form if you have one. Otherwise, you must indicate that you haven’t signed any.

Step 9. Indicate your resuscitation instructions if you have signed a “Do Not Resuscitate” directive. Attach it and place your initials next to option A on the form if you have. Otherwise, tick option B.

Step 10. Place your initials on the blank line on the form if you wish to authorize your agent to have the same rights concerning disclosing and using the HIPPA Act.

Step 11. Sign a blank line named “My Signature,” and then write the date you signed the document. If you can’t sign, one of your witnesses may sign for you to validate it.

Step 12. Another witness should print their name on the form, date, and sign it to verify the POA. Afterward, a notary public will stamp and notarize it.

Step 13. A doctor should also print their name on the form and sign it.

Other Arizona Forms By Type

Other Medical Power of Attorney Forms By State