Arkansas Durable Medical Power of Attorney Form

The durable medical power of attorney for health care document is created in accordance with § 20-6-103(c)§ 20-17-202, and requires at least two witnesses or a notary. It enables a patient, to be allowed to select another person, an agent, to become a facilitator of the patient`s health care treatment when they are no longer able to themselves through illness, for example if they are in a coma. If the patient is pregnant then a durable medical power of attorney for health care form is not valid.

How to Write


Pages 1 – 2. Enter relevant details into the blank fields.

1) Enter name of principal

2) Enter name of agent

3) Confirm name of agent

4) Enter name of alternative agent.

5) Signature of principal and date.

6) Signature and address` of two witnesses.