The Arizona Medical Power of Attorney form is a legal document that allows individuals to designate someone they trust to make healthcare decisions on their behalf if they become unable to do so. This form empowers the appointed agent to communicate with medical professionals and make choices regarding treatment options, ensuring that the individual's wishes are honored. Understanding the nuances of this form is essential for anyone looking to secure their healthcare preferences in advance.
In Arizona, the Medical Power of Attorney form plays a crucial role in ensuring that individuals' healthcare decisions are honored when they are unable to communicate their wishes. This legal document allows a person, often referred to as the "principal," to designate a trusted individual as their agent or healthcare proxy. The agent is empowered to make medical decisions on behalf of the principal in accordance with their preferences. The form must be completed with specific details, including the names of the principal and agent, and it should be signed in the presence of a notary public or witnesses to ensure its validity. It is essential for individuals to clearly articulate their healthcare preferences within the document, as this can guide the agent in making informed decisions during critical times. Additionally, the Arizona Medical Power of Attorney form can be revoked at any time, offering flexibility and peace of mind to those who may change their minds about their healthcare directives. Understanding the implications of this form is vital for anyone looking to safeguard their medical choices in unforeseen circumstances.
Arizona Medical Power of Attorney
This Medical Power of Attorney is made in accordance with the Arizona Durable Medical Power of Attorney Act. It grants the person named herein the authority to make health care decisions on behalf of the undersigned, when the undersigned is incapable of making their own health care decisions.
Principal’s Information:
Full Name: _________________
Address: _________________
Date of Birth: _________________
Social Security Number: _________________
Attorney-in-Fact’s Information:
Relationship to Principal: _________________
Phone Number: _________________
This document grants the Attorney-in-Fact named above the power to make health care decisions on my behalf, including decisions about refusing or consenting to treatment, access to medical records, and decisions regarding my physical examination. This power is effective immediately and will continue until I am again able to make these decisions for myself, unless I revoke it sooner.
In making health care decisions, the Attorney-in-Fact should consider my wishes as stated in this document or as otherwise known to them. If my wishes are unknown, the Attorney-in-Fact should act in my best interests, considering the benefits, burdens, and risks that might result from a given decision.
In accordance with the laws of the State of Arizona, this Medical Power of Attorney must be signed in the presence of an adult witness who is not the Attorney-in-Fact, not related to me by blood, marriage, or adoption, and not directly financially responsible for my medical care.
Additional Directives: (Optional)
__________________________________________________________________
Signatures:
Principal’s Signature: _________________ Date: _________________
Attorney-in-Fact’s Signature: _________________ Date: _________________
Witness’s Signature: _________________ Date: _________________
Printed Name of Witness: _________________
This document was prepared on the date indicated above and constitutes the Medical Power of Attorney of the Principal. It is advised to review this document periodically and to keep an accessible copy.
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