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Free Arizona Medical Power of Attorney Form

An Arizona medical power of attorney lets you choose the adult who makes health care decisions when you can't. Our step-by-step questionnaire builds a document that fits Arizona's short signing rules.

  • Download as PDF and Word
  • E-sign included

How It Works

1

Select Your Template

Choose the state or form type you need to start.

2

Fill In Your Details

Answer a few simple questions to customize your form.

3

Get Your Form

Download or print your custom document in PDF or Word.

What Is a Medical Power of Attorney in Arizona?

Arizona calls this document a health care power of attorney. It lets you name one or more adults to make health care decisions for you, and Arizona also allows it to cover funeral and disposition arrangements after your death.

Arizona Rules for a Health Care Power of Attorney

Arizona Revised Statutes § 36-3221 lists the requirements. The list is short, but each item matters.

Say What the Document Is

The writing must include language that clearly shows you intend to create a health care power of attorney. A vague note naming a relative is not enough.

Date It and Sign or Mark It

You date the document and sign it. A mark counts too. If you are physically unable to sign or mark, the notary or each witness must note on the document that you directly told them it expresses your wishes.

One Witness or a Notary Is Enough

You need either a notary or at least one adult witness. That person affirms they were present, that you seemed of sound mind, and that you were free from duress.

Who Cannot Witness or Notarize

The witness or notary cannot be:

  • The person you are naming to make medical decisions
  • Anyone directly involved in your health care when you sign

Extra Limits on a Single Witness

If only one person witnesses your Arizona medical power of attorney, that person also cannot be related to you by blood, marriage, or adoption. They also cannot be entitled to any part of your estate by will or by law.

Suspended Fiduciaries Cannot Serve

A licensed fiduciary whose license was suspended or revoked cannot act as your agent, unless related to you or the license has been reinstated.

Where Can You Register an Arizona Medical Power of Attorney?

Arizona has a free health care directives registry where hospitals can look up your document. A 2019 law moved the registry from the Arizona Secretary of State to a health information exchange designated by the Arizona Department of Health Services. Today that exchange runs the Arizona Healthcare Directives Registry.

You can submit your health care power of attorney, plus any later amendments or revocations. Registering your Arizona medical power of attorney is optional. It simply helps providers find the document in an emergency.

Mental Health Decisions Use a Separate Form

Arizona has a separate mental health care power of attorney with its own signing rules. If you want an agent to be able to admit you to an inpatient psychiatric facility, that form asks you to initial each paragraph granting that power. Consider signing both documents together.

How to Sign Your Arizona Medical Power of Attorney

These steps walk you through finishing your Arizona medical power of attorney form:

  1. Name your agent, and add backups if you want them.
  2. Include a clear statement that you are creating a health care power of attorney.
  3. Choose your signing route: one qualified adult witness or a notary.
  4. Date the document and sign or mark it in their presence.
  5. Have the witness or notary complete their affirmation.
  6. Give copies to your agent and doctors, and consider adding the document to the registry.

What to Include in Your Arizona Form

Arizona offers a sample form in § 36-3224, but any writing that meets the legal requirements works. Most people cover:

  • Their agent and any alternates
  • Specific treatment wishes, or a living will attached to the same packet
  • Funeral and disposition instructions, if they want the agent to handle them
  • When the agent’s authority begins

The state sample says the power takes effect when you can no longer make or communicate health care decisions yourself.