Arizona Living Will
This is a Living Will created in accordance with Arizona state laws. It outlines your preferences for medical treatment if you become unable to speak for yourself.
Patient Information:
- Name: ________________________________________
- Date of Birth: ________________________________
- Address: ______________________________________
- City: ________________________________________
- State: Arizona
- Zip Code: ___________________________________
Living Will Declaration:
If I am diagnosed with a terminal condition or an irreversible condition, I wish for my wishes regarding medical treatment to be respected.
My Preferences Are As Follows:
- I do not want life-sustaining treatment if it only prolongs the dying process.
- I do want pain relief even if it may hasten death.
- I wish to receive palliative care to maintain comfort and dignity.
- If I cannot communicate, my wishes regarding organ donation are: ________________________.
Medical Agent Information:
I appoint the following person as my medical agent to ensure my wishes are followed:
- Name: ________________________________________
- Phone Number: ________________________________
- Address: ______________________________________
Witnesses:
Two witnesses are required to validate this Living Will. The witnesses should not be related by blood or marriage, nor should they be entitled to any part of my estate.
- Witness 1 Name: _______________________________
- Witness 1 Signature: __________________________
- Witness 2 Name: _______________________________
- Witness 2 Signature: __________________________
Signatures:
By signing below, I confirm that this Living Will reflects my wishes and that I am of sound mind:
Patient Signature: ____________________________ Date: ________________
Thank you for taking the time to prepare this important document. It is essential to ensure your healthcare preferences are understood and followed.