Arkansas Living Will Template
This Living Will is made in accordance with the laws of the State of Arkansas.
Purpose: This document outlines my wishes regarding medical treatment in the event that I am unable to communicate my preferences.
Personal Information:
- Name: ________________________
- Date of Birth: ________________________
- Address: ________________________
- Phone Number: ________________________
Statement of Wishes:
If I become unable to make decisions about my medical care, I direct that my treatment be guided by the following preferences:
- In the event of a terminal illness or condition, I do not wish to receive life-sustaining treatment.
- If I am in a persistent vegetative state, I do not wish to receive treatment that prolongs my life.
- I wish to receive comfort care, such as pain relief and support for my emotional and spiritual needs.
Appointment of Health Care Proxy:
I hereby appoint the following individual to act on my behalf regarding medical decisions:
- Name of Proxy: ________________________
- Relationship: ________________________
- Contact Information: ________________________
Signatures:
By signing below, I confirm that this Living Will reflects my wishes regarding my medical treatment:
- Signature: ________________________
- Date: ________________________
Witness signatures are required for this document to be valid in Arkansas:
- Witness 1 Signature: ________________________
- Date: ________________________
- Witness 2 Signature: ________________________
- Date: ________________________
Note: This Living Will should be reviewed regularly and updated as necessary to reflect your current wishes.