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Arkansas Medical Power of Attorney Form

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Updated April 03, 2025

An Arkansas medical power of attorney grants a trusted friend or relative of the principal the power to make medical decisions on their behalf should the principal not have the capacity to do so. This is a useful document to have in place before you have surgery or some other scheduled medical procedure where you will be under anesthesia.

“Durable Power of Attorney for Health Care” Definition

“Durable power of attorney for health care” means a written advance directive that identifies an agent who is authorized to make healthcare decisions on behalf of the principal.[2]

“Durable power of attorney for health care” includes without limitation a document appointing a healthcare proxy executed under § 20-17-202;[3]

Statutory Form

No, there is no statutory form but the Arkansas Dept. of Health provides an official version.[4]

Sample

Download: PDF

Sources

  1. Ark. Code § 20-6-103
  2. Ark. Code § 20-6-102(4)(A)
  3. Ark. Code § 20-6-102(4)(B)
  4. www.healthy.arkansas.gov/wp-content/uploads/AppointmentHealthCareAgentForm.pdf