Life Care Planning: Health Care Office of Arizona Attorney General,
Power of Attorney– Updated 03/2020 Mark Brnovich
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HEALTH CARE POWER OF ATTORNEY
Instructions and Information
GENERAL INSTRUCTIONS: Use this form if you want to select a person, called an “agent”, to make
future health care decisions for you so that if you become too ill or cannot make those decisions for
yourself the person you choose and trust can make medical decisions for you. Be sure you
understand the importance of this document. It is a good idea to talk to your doctor and loved ones if
you have questions about the type of health care you do or do not want.
AUTOPSY CHOICE: If there is no legal reason to require an autopsy, you can decide if you want one
done when you die, or whether you want your agent to choose for you. There is usually a charge for
voluntary autopsies. You can help your family and loved ones by making your preferences on this
topic clear. For additional information on autopsies please review Arizona Revised Statutes §§ 11-
591 and 11-597.
ORGAN DONATION CHOICE (OPTIONAL): You can determine if you want to donate organs or
tissues, and if you do, what organs or tissues you want to donate, for what purposes, and to what
organizations. You also have the option of whole-body donation for research purposes. You can also
choose to have your agent decide. For additional information on Organ Donation, please review
Arizona Revised Statutes §§ Title 36, Chapter 7, Article 3 for the laws that pertain to it.
FUNERAL AND BURIAL CHOICE (OPTIONAL): You can determine, your funeral and burial
choices in this form. You can select if, upon your death, you would like to be buried and where, or if
you would like to be cremated and where your ashes will go, or you can select your agent to make
If you fill out this form, make sure you DO NOT SIGN UNTIL your witness or a notary public is
present to watch you sign it.
PLEASE NOTE: At least one adult witness, not to include the proxy if there is one, OR a notary public
must witness you signing this document.
DO NOT have the documents signed by both a witness and a notary, just pick one. If you do not
know a notary or cannot pay for one, a witness is legally accepted.
Witnesses or notary public CANNOT be anyone who is:
(a) under the age of 18
(b) related to you by blood, adoption, or marriage
(c) entitled to any part of your estate
(d) appointed as your agent
(e) involved in providing your health care at the time this form is signed