Arizona Living Will Template
This Living Will is created in accordance with the Arizona Revised Statutes, Title 36, Chapter 32, regarding advance directives.
Declarant Information:
- Name: ________________________
- Date of Birth: ________________
- Address: ______________________
- City: _________________________
- State: ____________ Zip Code: ____________
Introduction:
I, the undersigned Declarant, voluntarily make this Living Will to express my wishes regarding medical treatment in the event that I become unable to communicate my preferences.
Healthcare Decisions:
If I am diagnosed with a terminal condition or am in a persistent vegetative state, I do not wish to receive the following treatments:
- Cardiopulmonary resuscitation (CPR)
- Mechanical ventilation
- Tube feeding
- Other life-sustaining measures: ________________________
Personal Wishes:
In addition to the above, I wish to express the following specific preferences regarding my care:
- _______________________________________________________________________
- _______________________________________________________________________
- _______________________________________________________________________
Signatures:
This document must be signed and dated by me and can be witnessed or notarized to enhance its validity.
Declarant Signature: ________________________ Date: ________________
Witness Signature: ________________________ Date: ________________
Witness Signature: ________________________ Date: ________________
Notary Public:
State of Arizona, County of ______________
Subscribed and sworn before me this ______ day of ______________, 20____.
Notary Public Signature: ________________________ My Commission Expires: ________________