Arizona Health Care Power of Attorney (POA)

This document allows you to legally name a trusted person (your “agent”) to make health care decisions for you if you become too ill or injured to make those decisions yourself. It also lets you make choices about autopsy, organ donation, and funeral or burial wishes — all in one form.

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📄 Download the Full Arizona Life Care Planning Packet (PDF)


🧭 What Is a Health Care Power of Attorney?

This form:

This document is only activated if you're unable to make your own medical decisions.


📝 Step-by-Step Instructions


Section 1: Your Information

What it asks:

Helpful Tip: Use your legal name as it appears on your ID or medical records.


Section 2: Appoint Your Health Care Agent

What it asks:

Helpful Tip: Choose someone who knows your values and will be calm under pressure. Talk to them in advance and make sure they agree to serve.


Section 3: Authority of Your Agent

You may authorize your agent to:

You can also specify what decisions they cannot make, if any.


Section 4: Autopsy Instructions

You choose one (initial only one):

Helpful Tip: Autopsies are usually not required unless legally mandated (e.g., criminal investigation), but they can help families understand cause of death.


Section 5: Organ Donation Options

You may:

Helpful Tip: Include any known arrangements (e.g., donor card, university program) and be clear about your preferences.


Section 6: Funeral & Burial Preferences

Choices include:

Helpful Tip: While not legally binding in the same way as a will, this section can guide your family and reduce confusion or disagreement.


Section 7: Reference to Other Documents

You can indicate if you have:

Helpful Tip: If yes, attach copies to this form and store them together. Consider registering them with AZHDR.


Section 8: HIPAA Waiver

You can initial to give your agent full legal access to your protected health records, just like you would have.

Highly recommended for effective decision-making.


Section 9: Signature and Witnessing

You must sign this form in front of either:

Do not do both.

Witnesses/notaries cannot be:


✔️ Final Steps

  1. Sign the form correctly with a witness or notary

  2. Make copies for:

    • Your agent(s)

    • Your doctor(s)

    • Your hospital or care facility

    • Your records at home

  3. Attach other advance directives if you have them

  4. Register online (optional) at azhda.org


🛠️ Need Help?

Helpful can guide you through this form, answer questions about your options, and assist with registration and sharing. You don’t have to do this alone.

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