Arizona Medical Power of Attorney (POA) Form

Following Section 3224, Title 36 of Arizona Revised Statutes, residents of the state are empowered to delegate further medical and health-care decisions to a selected agent through the Durable Health Care Power of Attorney Form. The assigned agent gets instructions, but he or she is allowed to render therapeutic decisions on the principal’s behalf only after the principal loses the capacity to communicate his or her preferences.

The medical power of attorney form validates several actions and assigns a person that will receive powers and competencies to satisfy the principal’s choices covering the following matters:

  • Consent or refusal of health-care strategies
  • The attorney-in-fact gets admittance to medical histories.
  • The document authorizes the agent to discuss solutions to therapy and medical schemes with the health providers.
  • Wishes about autopsy
  • Preferences for anatomical donations
  • Funeral and burial instructions — though this is an optional part, some people prefer to coordinate all issues.
  • Living Will and Do Not Resuscitate Directive regulations

Arizona power of attorney forms – check out some other powers of attorney common in Arizona.

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The Arizona Durable Health Care Power of Attorney form also includes a section which the principal can dedicate to defining that he or she doesn’t want to transfer to the elected attorney. This part of the certificate is optional, and you can display the limitations in a free format.

Once the paper is authorized and acknowledged, it becomes valid and can only be revoked by the declarant or the court. In the following sections of this review, we will define the requirements, must-do issues, and restrictions while creating the Durable Health Care Power of Attorney document in Arizona.

Arizona Laws and Requirements

Determination to create a Durable Health Care Power of Attorney document is a serious matter which demands well-considered decisions and accuracy. Once the declarant has nominated a dependable somebody to become his or her representative in case of incapability or incapacitation drove by illness, injuries, or some other kind of health-threatening state, it is time to build a document. Below you will find all necessary recommendations and requirements that should be completed following §36-3221 Title 36 of Arizona Revised Statutes.

  • Any adult resident can create the form to delegate the responsibility for medical decisions to another individual.
  • Clear legal language

The document should provide clear definitions and describe precisely that the principal is firm about creating the Durable Health Care Power of Attorney.

  • The principal’s signature

The authenticity of the certificate demands that the principal should sign the paper to prove his intentions.

  • Authorization by a notary public or by an adult witness

To maintain legitimacy, one must provide one of these alternatives to validate the certificate. If the principal provides a witness signature, he or she doesn’t need to collect the notary authorization.

Only an individual of 18 years of age and older can witness the document under discussion. But there are some additional requirements for the signatory of choice or the notary public representatives. Make sure that you meet the demands. Otherwise, the validity of the Arizona Durable Health Care Power of Attorney certificate will be disgraced.

A witness or a notary public (if this option is preferable) can’t be:

  • linked to the principal by blood, adoption, and marriage.
  • entitled to the declarant’s estate
  • principal’s representatives
  • providers of medical therapy for the declarant

Once all requirements are satisfied, and the representatives and witnesses are chosen, the principal is welcome to proceed to generate the certificate.

Arizona Medical Power of Attorney Form Details

Document Name Arizona Medical Power of Attorney Form
State Form Name Arizona Durable Health Care Power of Attorney
State Laws Arizona Revised Statutes, Sections 36-3201 to 36-3224
Signing Requirements Notary Public OR One Witness
Who Can’t Be the Agent? Section 36-3221(E)
Who Can’t Be the Witness? Section 36-3221(C)
Avg. Time to Fill Out 8 minutes
# of Fillable Fields 21
Available Formats Adobe PDF

Popular Local Medical POA Forms

MPOA forms are some of the most commonly used ones within the United States. Take a look at some of the more requested durable power of attorney documents.

Filling Out the Form

The Arizona Durable Health Care Power of Attorney template is a self-sufficient document that obtains requirements and necessary knowledge that one will need to follow.

  • Download the Durable Health Care Power of Attorney Template

You are encouraged to use our form building software to create and download the template. Read the general instructions carefully to understand the purpose and importance of this document completely.

  • Declare the identity of the Principal

The principal should fill out the personal information on the lines following the sections. Submit your legal name and date of birth, age, full residency, and telephone number.
Principal's identity declaring section of medical power of attorney for Arizona

  • Designate the Representative 

This section is dedicated to your representative and an alternate representative in case the first person is unable to follow the directions due to some unforeseen reasons. Designating the agent, please submit his or her legal name, complete address, and phone numbers available.

Enter the same type of information about the alternate representative to complete the section properly.
Representative designating section of mpoa for Arizona

  • Define Restrictions and Limitations (if appropriate)

Read the third section of the Arizona Durable Health Care Power of Attorney template accurately to get acquainted with the general medical decisions you authorize your agent to make if you cannot communicate the wishes yourself.

After reading the standards, proceed to fill out the next section. Should you have any specific limitations that you want to submit, please, enter the date in a free format using “not applicable.” Describe what your representative should not do at any means.
Restrictions and limitations defining part of Arizona medical power of attorney form

  • Describe Autopsy Regulations

Under Arizona Law, Title 36 of Statutes, autopsy is a matter of choice and is not required until some specific circumstances. Therefore, the principal may indicate whether he or she permits autopsy. Put initials opposite the preferred alternative.
Part for autopsy regulations of Arizona medical power of attorney template

  • Specify Organ Donation Preferences

Under Arizona laws, this matter is also voluntary, and you, as a principal, can choose between two alternatives. You will find comprehensive information in Chapter 7, Title 36 of Arizona Statutes. Submit initials opposite the appropriate alternative. In case you give consent to organ donation, please, fill out additional data — specify the organs you are willing to donate, the purposes, and the institution.
Section for organ donation preferences of a mpoa for Arizona

  • Describe Funeral and Burial Instructions

The section is optional and covers the instructions for burial disposition. Submit your initials opposite the alternative you prefer and write down wishes (if any) on the empty lines.
Funeral and burial instructions description section of Arizona medical power of attorney document

  • Stipulate the Living Will Regulations

If you have an authorized living will, you must attach the document and put initials opposite the corresponding alternative.
Part for stipulating living will regulations of a document of medical power of attorney for Arizona

  • Specify the existence of the Prehospital Medical Care Directive and the Resuscitation Preferences Document

If you have signed one or both of these documents, make sure to submit this information in the section selecting the A alternative. If not, write down initials opposite the B alternative.
Part for informaion about pehospital medical care directive and resuscitation document of mpoa for Arizona

  • Make Decisions on HIPAA Waiver

If you authorize your representative to have the same rights regarding your medical records and health information, mark the section with your initials. Leave it blank in case you don’t give consent.
HIPAA Waiver decisions section of Arizona medical power of attorney

  • Sign the Document

Submit the principal’s signature and actual date to complete the document. In case the principal is physically unable to sign the document himself or herself, a witness can put a signature to execute the document. Print the witness’s name and date in day, month, year format.
Document signing part of Arizona medical power of attorney form

  • Collect the Witness’s Signature or a Notary Public Authorization

Under §36-3221 Title 36 of Arizona Revised Statutes, it is enough to have either an adult witness’s signature or a notary public authorization. Insert the chosen witness’s printed name, collect his or her signature, include the complete address, and report the date.

If you decide to authorize the paper with a notary public signature, you are empowered to use the corresponding section and leave the Witness section empty.
Witnesses signature part of mpoa template for Arizona

  • Collect a Statement from your Physician (if applicable)  

In Arizona, it is optional to get a statement from your physician. However, it is a good idea to collect his or her signature if you have discussed the possible treatment alternatives with your doctor. Follow the instructions and fill out the lines accurately.
Physician statement part of mpoa template for Arizona

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Other Arizona Forms
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Published: Jun 12, 2022