Official Arizona Living Will Form Modify Form Now

Official Arizona Living Will Form

A Living Will is a legal document that outlines an individual's preferences for medical treatment in the event they become unable to communicate their wishes. In Arizona, this form is crucial for ensuring that healthcare providers respect a person's choices regarding life-sustaining measures. Understanding the specifics of the Arizona Living Will form can empower individuals to make informed decisions about their healthcare.

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Overview

In Arizona, the Living Will form serves as an essential document for individuals who wish to outline their preferences regarding medical treatment in the event they become unable to communicate their wishes. This form allows individuals to specify the types of life-sustaining measures they would or would not want, such as resuscitation efforts, mechanical ventilation, and feeding tubes. By completing a Living Will, a person can ensure that their healthcare decisions align with their values and beliefs, providing clarity for family members and medical professionals during difficult times. The form typically requires the individual's signature and may need to be witnessed or notarized, depending on state regulations. Understanding the nuances of this document can help individuals make informed choices about their future medical care and facilitate conversations with loved ones about end-of-life preferences.

Form Example

Arizona Living Will

This Arizona Living Will is a legal document that sets forth your wishes regarding health care in the event that you become unable to make decisions for yourself. Arizona law, specifically under the Arizona Living Will statutes, allows you to express your desires concerning medical treatment at the end of your life. Please provide the requested information accurately.

Personal Information

Full Name: __________________________________________

Date of Birth: ________________________________________

Address: _____________________________________________

City: ________________ State: AZ Zip Code: _________

Living Will Declarations

This section of the Arizona Living Will allows you to make specific declarations about your health care wishes.

Life-Sustaining Treatment

In the situation where I am unable to make my own health care decisions and am in a state that is either terminal or where I am unable to recover (as certified by two physicians), my directions for life-sustaining treatment are as follows:

  1. I wish to receive all available life-sustaining treatments, including artificially provided food and water, to extend my life as long as possible.
  2. I do not wish to receive life-sustaining treatments, except as necessary to provide comfort care, if it is determined that I am in an irreversible terminal condition and my death is imminent.
  3. I wish to have artificially provided food and water withdrawn or withheld if I am in a persistent vegetative state and recovery is not expected.

Pain Relief and Comfort Care

Regardless of the choices above, I request the following regarding pain relief and comfort care (please specify your preferences):

  • _________________________________________________________
  • _________________________________________________________

Additional Instructions

You may provide any additional instructions or limitations regarding your health care wishes below:

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

Designation of Health Care Proxy

If I am unable to make health care decisions for myself, I designate the following individual as my health care proxy to make decisions on my behalf:

Name: __________________________________________

Relationship: ___________________________________

Phone Number: __________________________________

Alternative Contact: ____________________________

Signature

My signature below indicates that I understand the purposes and effects of this document.

Signature: ________________________________________ Date: _________________________

Witness Signature: ________________________________ Date: _________________________

I declare that the individual who signed or acknowledged this living will is personally known to me, that he/she signed or acknowledged this living will in my presence, and that he/she appears to be of sound mind and under no duress, fraud, or undue influence.

File Characteristics

Fact Name Description
Purpose The Arizona Living Will form allows individuals to outline their preferences for medical treatment in the event they become unable to communicate their wishes.
Governing Law This form is governed by Arizona Revised Statutes § 36-3201 to § 36-3210.
Eligibility Any adult who is 18 years or older can complete a Living Will in Arizona.
Witness Requirements The form must be signed in the presence of two witnesses who are not related to the individual or entitled to any portion of their estate.
Revocation A Living Will can be revoked at any time by the individual, either verbally or in writing.
Healthcare Proxy While a Living Will specifies treatment preferences, it does not appoint a healthcare proxy; a separate document is needed for that purpose.
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