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Arkansas Advance Care Plan and Medical Power of Attorney

Names a health care decision maker and records instructions for periods when the principal cannot decide.

Jurisdiction
Arkansas
Purpose
Medical & health care
Source / form version
No current revision date printed; department-published two-page form.
Resource format
PDF
Signing
Sign before two competent adult witnesses or acknowledge before a notary. Neither witness may be the agent; at least one must be unrelated and not entitled to the estate.
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Sources checked: 2026-11-13. General information, not individual legal advice.

Name an agent and alternate

The Arkansas advance care plan combines an agent appointment with treatment instructions. Write current contact information for the first agent and an alternate who can step in. Choose someone willing to ask questions of clinicians and communicate your wishes, particularly when relatives disagree about what should happen.

Sources: [1] [2]

Read the quality-of-life and treatment choices together

The first page describes conditions you may consider an unacceptable quality of life and then asks about treatments if the condition is irreversible. Read those linked instructions before marking yes or no. Use the additional-instructions area for preferences the boxes do not explain, and discuss medical terms with a clinician.

Sources: [1] [2]

Choose one signing method

The second page offers two witness declarations or a notarial acknowledgment. If using witnesses, both must be competent adults other than the appointed agent; at least one must also meet the unrelated and non-beneficiary requirements. Keep both pages together and provide a completed copy to the agent, alternate, and health care providers.

Sources: [1] [2]

Common questions

Must I use both witnesses and a notary?

No. The department form allows either two qualified witnesses or notarization. Complete the chosen method fully.

Sources: [1] [2]

Does naming an agent force me to choose every treatment option?

No. An agent appointment and written treatment instructions have different functions. Make deliberate choices, explain any limits, and discuss unanswered treatment questions with your care team.

Sources: [1] [2]

Related forms and guides

Sources and verification

  1. Arkansas Department of Health: source and instructions (opens in a new tab)
  2. Arkansas Code §20-6-103 (opens in a new tab)
  3. Arkansas Act 1264 of 2013 — enacted health care decisions provisions (opens in a new tab)

Primary publisher file and instructions checked on 2026-11-12. External link only; no independent attorney review or suitability determination is claimed. Official enacted act linked as primary historical legislation; the act date is not represented as current consolidated code.

The date above records a source check. It does not certify that a form is suitable for your circumstances or that an attorney has reviewed your document. Read the publisher’s current instructions before use.