Arizona Living Will Form (Advance Directive)

The Arizona living will form is also known as an Advance Health Care Directive is available so a patient may pass over the responsibility for making their medical health care decisions to a named person or persons should the patient end up in a condition which means they are unable to make these decisions themselves. This passing of responsibility also extends so far as making and end of life decision should the patient wish to give this permission. This document is created with respects to the US statutes §§36-3201 to 36-3297 and  requires at least one notary and one witness.

How to Write

Step 1 – Download the document and carefully read all of the  instructions. Fill in the required details below.

Required

1) Principals Information

  • Print full name
  • Date of birth
  • Address
  • Age
  • Telephone number

 

2) End of life decisions.

Initial the relevant following selections.

  • `A`choice not to prolong life.
  • `B` choice to prolong life. If selecting section `B` then also initial any of the following: `B(i) resuscitation `B(ii)` artificial administration of food and fluids `B(iii)` to be taken to hospital.
  •  `C` Give instructions  regarding consciousness during pregnancy.
  • `D` Give treatment until condition is reasonably known.
  • `E` prolong life to the greatest possible extent

 

(3) Other wishes

  • `A` Enter details of principals other wishes regarding end of life decisions.
  • `B` Do not enter details of principals other wishes regarding end of life decisions.

 

4) Signatures

  • Enter the principal`s signature.
  • Date Completed.

 

5) Witness

Enter the signatures of two adult witnesses or a notary.

Required

  • Signature
  • Printed name
  • Date
  • Residence address and judicial district (If notary).

If a witness is a notary then enter.

  • County/Judicial district
  • Day/Month/Year
  • Officer name/Title
  • Signature of notary public or officer
  • Date commission expires