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HEALTH CARE POWER OF ATTORNEY
I, , of , , as Principal, designate:
| Agent Name: |
| Address: |
| , |
| Phone: | Home: Work: |
| Relation, if any: |
as my agent for all matters relating to my health care, including, without limitation, full power to give or refuse consent to all medical, surgical, hospital and related health care, including the provision of life-sustaining treatment This power of attorney is effective on my inability to make or communicate health care decisions. All of my agent's actions under this power during any period when I am unable to make or communicate health care decisions or when there is uncertainty whether I am dead or alive have the same effect on my heirs, devisees and person representatives as if I were alive, competent and acting for myself.
SECOND ALTERNATE AGENT
| Agent Name: |
| Address: |
| , |
| Phone: | Home: Work: |
I have not completed or attached a living will.
I completed a prehospital medical directive pursuant to section 36-3251, Arizona Revised Statutes.
If any provision in 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.
any needed organ or parts the following part or organs listed:
_____ I do not want to make an organ or tissue donation and I do not want my agent or family to do so.
. FUNERAL AND BURIAL DISPOSITION
My agent has authority to carry out all matters relating to my funeral and burial disposition wishes in accordance with this power of attorney, which is effective upon my death.
This health care directive is made under section 36-3221, Arizona Revised Statutes, and continues in effect for all who may rely on it except those to whom I have given notice of its revocation.
(YOU MUST DATE AND SIGN THIS POWER OF ATTORNEY)
Signed on _____ day of _______________, _____.
| Signature: | ________________________________________ |
| Name: |
| Address: |
| County |
| COUNTY OF | ) |
| COUNTY OF ______________________________) |
| _____ | Arizona requires that special provisions within the document be separately initialed or signed. |
| _____ | should sign the Physician Affidavit. |
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It's fast and simple to grant or receive the support you need with a free Arizona Medical Power of Attorney template from Rocket Lawyer:
This route is, in most cases, much less expensive and less time-consuming than meeting and hiring a traditional attorney. If necessary, you may prepare a Medical PoA on behalf of your spouse, an elderly parent, or another family member, and then have them sign it once you've drafted it. Please note that for this document to be considered legally valid, the principal must be an adult who is mentally competent when they sign. If the principal has already been declared incompetent, a conservatorship could be necessary. In this scenario, it would be a good idea for you to talk to an attorney .
Every person over 18 ought to have a Medical Power of Attorney. While it can be unpleasant to think about, there will likely come a time when you are not able to make your own healthcare decisions. Typical circumstances where power of attorney might be helpful include:
Whether this Arizona Medical Power of Attorney has been generated as part of a long-term plan or created in response to an emergency, witnesses and/or notarization will often help to protect your document if someone doubts its validity.
Sometimes, when discussing the topics of elder care or estate planning with medical professionals, you or a loved one might hear the terms "healthcare power of attorney", "medical power of attorney" and "healthcare proxy" being used interchangeably. In reality, they are the same. That being said, please keep in mind that it's certainly possible to give power of attorney over affairs that aren't related to health care. In that case, "proxy" is not normally used.
Arizona Medical PoA forms are usually straightforward; however, you or your agent(s) might still have legal questions. Finding a legal professional to comment on your Arizona Medical Power of Attorney may be relatively time-intensive. An easier option is through Rocket Lawyer attorney services. If you sign up for a Premium membership, you can get your documents reviewed or send specific questions. As always, Rocket Lawyer is by your side.
The fees associated with finding and hiring a conventional legal provider to write a Medical Power of Attorney might total anywhere between $200 and $500. Different from many other websites you might stumble upon, Rocket Lawyer offers much more than a Power of Attorney template. If you ever require help from a lawyer, your membership provides up to a 40% discount when you hire an Rocket Lawyer network attorney.
As a Rocket Lawyer member, you can edit it, save it as a Word or PDF document, or print it out. In order to complete your Power of Attorney, it should be signed. Take care to give a copy of the signed document to your agent(s) and care providers.
The specifications and restrictions for PoA forms will vary by state; however, in Arizona, your Power of Attorney must be acknowledged by a notary public or signed by one witness. Witnesses to this PoA must not be anyone involved in your care, nor any relative, spouse, adoptee, heir, or any other beneficiary. Finally, as a general standard, witnesses should be over 18 years old, and no witness should simultaneously be your PoA agent.
See Arizona Medical/Healthcare Power of Attorney law: § 36-3221
