Arkansas Declaration of Living Will Form

The Arkansas declaration of living will form is a legal document that is recognized by the courts in the state of Arkansas, that allows an individual of age, while they are able to do so, to make and record their specific and personal health care decision, in the event they are ever faced with any end of life scenario. This will not only ensure that the Principal is very clear with what their wishes are but provide a hand-guided description to health care representatives, family, friends and health care providers.

Laws – 20-17-201, et seq.

How to Write

Step 1 – Establish the Principal with relation to the instruction to be placed within this document by placing their full name in the first line of the document

Step 2 – Life Sustaining Treatments –

  • The Principal must read, or have read to them (should they be unable to do so) the first two paragraphs of the document. Should they disagree with any portions of these paragraphs they may strike through them and initial:
  • In section 1 the Principal may select and check all boxes that would be applicable to their decisions as to the treatment they wish to authorize Should the Principal wish to specify other medical directives, they may enter them into the lines provided in this section

Step 3 – Artificial Nutrition and Hydration – The state of Arkansas requires a Principal to separately, from other directives, to initial the lines in section 2 that would best reflect their wishes regarding nutrition and hydration when the Principal is no longer able to decide on their own:

  • Initial each line that would indicate the Principal’s wishes’
  • Provide the date of signature in dd/m/yy format
  • Principal must then submit their signature to this section

Step 4 – Witness Acknowledgement and Information – The witnesses  must read the and attest to the paragraph in this section. If in agreement, they witnesses must provide the following:

  • Witnesses Signatures (respectively)
  • Street address(es)
  • City, State and Zip Code

Step 5 – Durable Power of Attorney for Health Care – In this section, the Principal will be able to appoint  an Attorney in Fact/Agent to oversee the wishes of the Principal by use of this document.

  • Enter the name of the Principal/Declarant at the top of the page
  • In the first line at the beginning of the paragraph the Principal must enter the name of their appointed agent
  • Principal must carefully review the remainder of the paragraph
  • Should the Principal so desire, they may then appoint and alternate Attorney in Fact/Declarant, in the event the initial agent is unable or unwilling to serve in this capacity
  • Enter the name of the initial agent in the first line of the second paragraph and then the alternate agent’s name in the second line of the paragraph
  • The Principal must acknowledge appointment of the agents by dating their signature in dd/m/yy formati
  • The Principal must then, again, submit their sugnature

Step 4 – Witness Acknowledgement-

  • Witnesses must enter the name of the declarant, read the remainder of the paragraph
  • If in agreement the witnesses, in the presence of the Principal and one another, must enter:
  • Witnesses names
  • Street Addresses
  • City
  • State
  • Zip Code