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Other Names: Arkansas Healthcare POA Arkansas Healthcare Power of Attorney Arkansas Medical POA Arkansas Healthcare Proxy
Arkansas Medical Power of Attorney document preview

What is an Arkansas Medical Power of Attorney?

An Arkansas Medical Power of Attorney is a legal document that grants a selected person permission to make healthcare decisions on your behalf, such as accepting or refusing a specific medical treatment, if you cannot do so. 
The individual granting control is called the "principal," while the individual or entity receiving authority is known as the "agent." Suitable for Arkansas residents, our Power of Attorney for health care can be used in Pulaski County, Benton County, Washington County, and in all other regions across the state. All Arkansas Healthcare PoA forms from Rocket Lawyer can be edited for your unique situation. With this official legal document on hand, your agent(s) can offer verification to healthcare providers and other parties that they can make choices for you.

When to use an Arkansas Medical Power of Attorney:

  • Your health is declining and you want to assign someone to make healthcare decisions if, and when, you can't.
  • You're healthy but you want to have a say in who takes care of your medical decisions, if you're unable to.

Sample Arkansas Medical Power of Attorney

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. DESIGNATION OF HEALTH CARE PROXY. If I should become permanently unconscious, incompetent, or otherwise mentally or physically incapable of communication, I direct my attending physician, pursuant to the Arkansas Rights of the Terminally Ill or Permanently Unconscious Act, to follow the instructions of my Agent whom I appoint as my Health Care Proxy ("Agent") to decide whether life-sustaining treatment


Agent Name:




Phone: Home: Work:

Relation, if any:


In exercising this authority, my Agent shall make health care decisions that are consistent with my desires as stated in this document or otherwise made known to my Agent.




Agent Name:




Phone: Home: Work:

. NOMINATION OF GUARDIAN. If a Guardian of my person is to be appointed for me, I nominate my Agent (or Alternate Agent) to serve as my Guardian.

. NOMINATION OF GUARDIAN. If a Guardian of my person is to be appointed for me, I nominate







to serve as my Guardian.




1. HOLD HARMLESS. All persons or entities who in good faith endeavor to carry out the terms and provisions of this document shall not be liable to me, my estate, my heirs or assigns for any damages or claims arising because of their action or inaction based on this document, and my estate shall defend and indemnify them.


2. SEVERABILITY. If any provision of this document is held to be invalid, such invalidity shall not affect the other provisions which can be given effect without the invalid provision, and to this end the directions in this document are severable.


3. STATEMENT OF INTENTIONS. It is my intent that this document be legally binding and effective. If the law does not recognize this document as legally binding and effective, it is my intent that this document be taken as a formal statement of my desire concerning the method by which any health care decisions should be made on my behalf during any period in which I am unable to make such decisions.




I have read and understand the contents of this document and the effect of this grant of powers to my Agent. I am emotionally and mentally competent to make this declaration.


Signed on ______ day of ____________________, _____.



Signature: ________________________________________







voluntarily signed this writing in my presence.


We, the undersigned, state that we are both at least 18 years of age.





Witness Signature: ________________________________________



Date: _________________________



Witness Signature: ________________________________________



Date: _________________________

Arkansas Medical Power of Attorney FAQs

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  • How can I get an Arkansas Medical Power of Attorney form online for free?

    It's very easy to grant or receive the support you might need using a free Arkansas Medical Power of Attorney template from Rocket Lawyer:

    1. Make your PoA - Provide a few simple details and we will do the rest
    2. Send or share it - Go over the PoA with your agent(s) or get legal advice
    3. Sign it and make it legal - Optional or not, witnesses/notarization are ideal

    This solution is often much more affordable and convenient than meeting and hiring the average provider. If necessary, you can fill out this Medical PoA on behalf of an elderly parent, a spouse, or another family member, and then help them sign after you've drafted it. Please keep in mind that for a PoA form to be valid, the principal must be mentally competent when they sign. If the principal is already unable to make their own decisions, a court-appointed conservatorship might be required. When managing such a scenario, it is important to speak with an attorney .

  • Who should have a Power of Attorney for healthcare in Arkansas?

    Anyone who is over 18 ought to have a Medical Power of Attorney. Though it can be tough to acknowledge, a day will likely come when you are not able to make your own healthcare decisions. Here are a few typical circumstances in which a PoA may be helpful:

    • You will be hospitalized for a surgical procedure
    • You are aging or dealing with ongoing health issues
    • You are currently managing a terminal condition
    • You have plans to live in an adult care facility

    Regardless of whether your Arkansas Medical Power of Attorney is being generated as part of a long-term plan or produced as a result of an unexpected emergency, notarization and/or witnesses will often help to protect your document if a third party disputes its authenticity.

  • Is there a difference between an Arkansas Healthcare Proxy and an Arkansas Medical Power of Attorney?

    At times, in the process of researching the topics of elder care and/or estate planning, you or a loved one may see the terms "healthcare power of attorney", "medical power of attorney" and "healthcare proxy" used together. In actuality, they're the same. That said, you should keep in mind that it's entirely possible to grant agency over matters that aren't related to medical care. In that case, "proxy" is not commonly used.

  • Should I hire a lawyer to review my Arkansas Medical PoA?

    Arkansas Medical PoA forms are generally simple; however, you could have legal questions. Finding a lawyer to look over your Medical Power of Attorney could take longer than you expect if you attempt to do it on your own. An easier approach would be through attorney services at Rocket Lawyer. Rocket Lawyer members have the ability to ask for guidance from an experienced lawyer or send additional questions. As always, you can be confident that Rocket Lawyer is by your side.

  • How much might it typically cost for an attorney to help me get a Power of Attorney form for health care in Arkansas?

    The fees associated with finding and hiring your average lawyer to write a Medical Power of Attorney might total anywhere from $200 to $500, based on your location. Rocket Lawyer is not a run-of-the-mill Power of Attorney template website. With us, anyone under a Rocket Lawyer Premium membership can take advantage of up to 40% in savings when hiring an attorney from our Rocket Lawyer attorney network.

  • Will I have to take additional actions after creating an Arkansas Medical Power of Attorney?

    Each Power of Attorney has a list of tips on what to do next. You are encouraged to engage with the document in any of these ways: making edits, downloading it in PDF format or as a Word file, and signing it. Finally, ensure that your agent(s) and care providers get a copy of your final document.

  • Does a Medical Power of Attorney need to be notarized, witnessed, or recorded in Arkansas?

    The specific rules and restrictions vary by state; however, in Arkansas, your Power of Attorney must be acknowledged by a notary public or signed by two witnesses. At least one witness to this PoA must be someone who is not a relative, spouse, adoptee, heir, or any other beneficiary. Finally, as a general standard, your witness(es) will need to not be under the age of 18, and no witness should also be your PoA agent.

    See Arkansas Medical/Healthcare Power of Attorney law: Title 20, Subtitle 2, Ch. 6, Subchapter 1

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