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.
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.
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:
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.
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