Arizona Living Will
This Living Will is a legal document that records your wishes regarding medical treatment if you become unable to communicate or make decisions due to incapacity or terminal illness. It is crafted in accordance with the Arizona Life Care Planning statutes, ensuring your decisions are honored in the state of Arizona.
Personal Information
Full Legal Name: ___________________________
Date of Birth: ___________________________
Address: __________________________________
City: _____________________ State: AZ Zip: ___________
Telephone: ________________________________
Healthcare Directives
Below, specify your preferences regarding medical treatments and interventions in situations where recovery is not expected. These choices will guide your healthcare providers and loved ones when making decisions about your care.
- I wish to receive all available medical treatments and interventions, regardless of my condition or prognosis.
- I wish to receive treatment only if it will alleviate pain and suffering, and I do not want treatments that would only prolong the process of dying.
- I do not wish to be kept alive by artificial means, such as mechanical ventilation, if I am in a permanent vegetative state or terminally ill with no expectation of recovery.
Additional Instructions: ________________________________________________________________
_______________________________________________________________________________________
Designation of Healthcare Agent
In the event that I am unable to make my own healthcare decisions, I designate the following individual as my Healthcare Agent:
Name: ___________________________ Relationship: ___________________________
Address: _______________________________________________________________
Primary Phone: ______________________ Alternate Phone: ____________________
Signature
I understand that by signing this document, I am providing clear instructions about my healthcare preferences. I affirm that I have the right to make these decisions and that I have made them after careful consideration.
Date: ______________________
Signature: __________________
Witness (1) Name: _____________________ Signature: _________________ Date: ____________
Witness (2) Name: _____________________ Signature: _________________ Date: ____________
Witnesses affirm that the individual signing this document is of sound mind and under no duress or undue influence.
Note: Two adult witnesses or a notary public must observe the signing of this Living Will. Witnesses should not be healthcare providers, related to you by blood or marriage, or entitled to any portion of your estate upon your death.