Arizona Living Will
Arizona Living Will
This Arizona Living Will Template is a legally binding document designed to express the wishes of [Your Name] regarding medical treatment and end-of-life care. This document ensures that preferences are honored and respected even if [Your Name] is unable to communicate them directly.
I. Declaration
I, [Your Name], residing at [Your Company Address], being of sound mind and memory, do hereby declare this to be my Living Will. This document is intended to guide my family and healthcare providers in making decisions about my medical care and treatment based on my values and preferences.
II. Appointment of Healthcare Representative
I designate the following individual as my healthcare representative to make medical decisions on my behalf when I am unable to do so:
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Name: [Healthcare Representative’s Name]
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Relationship: [Relationship with Healthcare Representative]
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Phone Number: [Healthcare Representative’s Phone Number]
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Address: [Healthcare Representative’s Address]
III. General Instructions for Medical Treatment
I wish to make clear my desires concerning any medical treatment, procedures, medications, and interventions, including:
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I do not wish to receive life-sustaining treatment if I am in a persistent vegetative state.
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If my condition is deemed terminal and irreversible by two physicians, I do not wish to undergo further aggressive treatment.
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I prefer to receive hospice care at home surrounded by loved ones.
IV. Specific Instructions
Should I become incapacitated, I issue the following specific instructions regarding my care:
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I do not wish to be resuscitated if my heart stops beating.
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I do not wish to be placed on artificial life support machines.
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I request aggressive pain management to ensure my comfort.
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I wish to donate my organs for transplantation purposes.
V. Signature and Witnesses
I sign this Living Will on [Date] in the presence of the following witnesses, who also sign in my presence.
Declarant
[Your Name]
Witness 1
Name: [Witness 1 Name]
Address: [Witness 1 Address]
Witness 2
Name: [Witness 2 Name]
Address: [Witness 2 Address]
VI. Notary Acknowledgment
County of [County Name], State of Arizona
On this [Date], before me, [Notary's Name], a notary public in and for the said state, personally appeared [Your Name], known to me to be the person described in and who executed the foregoing instrument, and acknowledged that he/she executed the same as his/her free act and deed.
Witness my hand and official seal.
Notary Public: [Notary's Name]
My Commission Expires: [Expiration Date]
