Arkansas Medical Power of Attorney Form [PDF]

The Arkansas power of attorney, or healthcare power of attorney, is a legal document that grants authority to the attorney-in-fact to represent the principal and make healthcare decisions on their behalf.

The medical power of attorney form includes a list of life-sustaining treatments that the principal can select to receive or withhold if their health deteriorates to the point that they can’t make such decisions themselves.

The principal can also instruct the attorney-in-fact or the agent to withhold the artificial nutrition or hydration for them.

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

Laws and Legal Requirements

Title 20, Subtitle 2, Chapter 6, Subchapter 1 of the Arkansas Code outlines the status of the medical power of attorney in Arkansas, and § 20-6-103 provides that the medical power of attorney must be signed before a notary public or at least two witnesses.

None of the witnesses can be a minor or be the principal’s agent. Neither of the witnesses can be related to the principal by blood, marriage, adoption, or someone entitled to any part of your estate.

The medical power of attorney loses effectiveness after the principal dies, revokes the document, or gets divorced if the agent is their spouse. (§ 20-6-104)

How to Write a Medical Power of Attorney in Arkansas

To draft a valid medical power of attorney in Arkansas, you should follow the step-by-step process outlined below:

How to Write a Medical Power of Attorney

#1. Access the Medical Power of Attorney Form

Here, you can find the Arkansas medical power of attorney template. All you have to do is fill it out using our professional and easy-to-use document builder.

At the very beginning of the document, you should enter the following details:

Principal’s name, mailing address, and contact details
Date of medical power of attorney issuing

#2. Appoint a Healthcare Representative

In this section, you should provide details about the person you want to appoint as your attorney-in-fact to make decisions about your healthcare in case you are not able to.

You should find someone of legal age and with the legal capacity to be appointed. The agent will be authorized to represent you within the framework of the medical power of attorney rights and limitations.

The attorney-in-fact, or agent, should be someone you trust, considering that they will have the authority to make important decisions about your health. In this section, you should enter your agent’s full name, mailing address, and contact details.

#3. Identify an Alternative Healthcare Representative

The alternative healthcare representative, or secondary agent, is a person who will represent you as your healthcare agent in case your primary agent is not able or not willing to represent you.

The secondary agent should satisfy the same requirements as the primary agent. You can appoint one, two, or more secondary agents in the medical power of attorney.

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

Arkansas state law provides that the medical power of attorney becomes valid only after the principal signs the document in front of at least two adult witnesses. Instead of two witnesses, the document can be acknowledged by the notary public.

The witness cannot be an agent, and one of the witnesses cannot be related to the principal by blood, marriage, or adoption and be entitled to any portion of the principal's estate.

#5. Notarize the Form

To make a power of attorney valid, you can also have it acknowledged by the notary public. They will check your identity and confirm on the document that you have signed it.