Arizona Living Will Template
This Living Will is created in accordance with Arizona state laws. It outlines your preferences regarding medical treatment in the event that you become unable to express your wishes. Please fill in the blanks with your specific information.
1. Declarant Information:
- Name: ________________________________
- Address: ______________________________
- City, State, Zip: ______________________
- Date of Birth: ________________________
2. Designation of Health Care Instructions:
If I am unable to make medical decisions for myself, I direct that my healthcare providers follow these instructions:
- If I am diagnosed with a terminal condition, I do not wish to receive:
- Life-sustaining treatment
- Resuscitation
- Mechanical ventilation
- If I am in a persistent vegetative state, I do not wish to receive:
- Artificial nutrition and hydration
- Other life-prolonging measures
- Other specific wishes: ________________________
3. Signature:
I understand that this document will take effect when I am unable to make decisions regarding my medical care.
Signature: ________________________________
Date: ______________________
4. Witness Information:
Signatures of two witnesses are required. Witnesses must not be related to me by blood, marriage, or adoption, nor be beneficiaries of my estate.
- Witness 1: ________________________________ Date: ________________
- Witness 2: ________________________________ Date: ________________
This document expresses my wishes and should be honored by my healthcare providers. Keep a copy with your important papers and provide copies to your loved ones.