Arizona Medical Power of Attorney Form [PDF]

Discover the importance of the medical power of attorney in the Arizona healthcare system and use our medical power of attorney template.

Last update: 27 Mar 2024

Arizona Medical Power of Attorney Form [PDF]

An Arizona medical power of attorney, or a healthcare power of attorney, is a legal document that delegates the authority to make medical care decisions from one person, called the principal, to another person, called the agent, or the attorney-in-fact.

The medical power of attorney form should be issued when the principal is facing serious surgery that will make the principal unable to make decisions about their healthcare. 

This document then enables another person to make decisions on behalf of the principal, according to the outlined medical power of attorney rights and limitations.

Laws and Legal Requirements for a Medical Power of Attorney in Arizona

Laws and Legal Requirements

Title 36, Chapter 32 of the Arizona Revised Statutes regulates the status of medical power of attorney in Arizona.

Moreover, § 36-3221 provides that the medical power of attorney must be signed before at least one witness or a notary public. The witness or notary cannot be someone who is involved in your health care, your agent, blood relative, adoptive family member, spouse, or someone who will inherit from your estate. 

§ 36-3223 provides that your power of attorney remains valid until you revoke it or the court removes your agent’s powers.

How to Write a Medical Power of Attorney in Arizona

Here, you can see the step-by-step process of writing the Arizona medical power of attorney.

How to Write a Medical Power of Attorney

#1. Access the Medical Power of Attorney Form

Here, you can find the medical power of attorney template. You can fill it out by completing relevant questions with the guidance of our advanced document builder. 

First, you should enter the basic information about the principal (their full name, mailing address, and contact information) and the date of issuing the medical power of attorney.

#2. Appoint a Healthcare Representative

This should be a person that you want to authorize to represent you and make decisions about your healthcare on your behalf. This should be an adult with the legal capacity to represent you. You should choose someone you can trust and who is physically available to act on your behalf.

In this section, you should enter:

  • Agent’s full name

  • Agent’s mailing address

  • Agent’s contact details

#3. Identify an Alternative Healthcare Representative

This person is also called the secondary attorney-in-fact or a secondary agent. They act and make decisions about your healthcare in case your primary agent becomes incapacitated or becomes, in some way, unable to represent you.

The secondary agent should fulfill the same exact requirements as the primary agent. You can name one or more people as your secondary agents.

#4. Define Agents Rights and Responsibilities

Here, you can include the medical power of attorney rights and limitations that your agent can have.

You can specify what treatments you want or don’t want to be subjected to, or define if you would like to be subjected to the life-maintaining treatment. 

You can also outline if you would like to be subjected to an autopsy or if you would like your principal to have access to your medical records when making decisions on your behalf.

#5. Identify the Witnesses and Have Them Sign the Form

Arizona state law requires you to sign your medical power of attorney in front of at least one witness. The witness can be replaced by the notary public.

The witness cannot be:

  • Someone who is involved in your health care

  • Your agent

  • Your blood relative, adoptive family member, or spouse

  • Someone who will inherit from your estate

#6. Notarize the Form

Finally, the medical power of attorney should be acknowledged by the notary public. Otherwise, the document won’t have any legal effect.

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