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Arkansas advance directive packet
Download the August 2026 Arkansas advance directive packet, the living will declaration tracking both statutory forms in Ark. Code § 20-17-202(b)-(c) plus a companion durable power of attorney for health care under the Arkansas Healthcare Decisions Act, for recording your end-of-life treatment wishes and naming the person who speaks for you. Get both instruments in editable Word and true fillable PDF. Add the completed sample PDF if you want a filled-in reference.
A state-specific living will declaration and durable power of attorney for health care packet, reviewed against the current Arkansas statute and ready for instant secure access.
The living will tracks Ark. Code § 20-17-202(b) (terminal condition) and (c) (permanently unconscious) (you may complete either or both) with all four statutory nutrition-and-hydration directives presented as initialed elections, plus a directives page for your own instructions.
Appoints your agent for health care decisions under the Arkansas Healthcare Decisions Act, with your election of when authority begins, your instructions and limitations, and the witness attestation clause Ark. Code § 20-6-103(c)(3) requires when you choose the two-witness execution path.
Download the files, complete them on your own device, then sign each instrument before a notary or two witnesses. Your personal details are never entered into an online form builder.
This download includes 2 documents in editable Word and fillable PDF formats. Use the Word version for editing; the fillable PDF can be completed on screen, then printed and signed.
Review the complete text of both instruments below before purchasing. Your licensed download (both instruments in editable Word and fillable PDF) is delivered after checkout.
ARKANSAS LIVING WILL
DECLARATION
PUBLICLEGAL FORM 1918-A · REV. 08/2026
Declaration Relating to Use of Life-Sustaining Treatment
I, ______________________________________________________________________
Terminal Condition
If I should have an incurable or irreversible condition that will cause my death within a relatively short time, and I am no longer able to make decisions regarding my medical treatment, I direct my attending physician, pursuant to the Arkansas Rights of the Terminally Ill or Permanently Unconscious Act, to:
Initial ONE alternative:
Initial: withhold or withdraw treatment that only prolongs the process of dying and is not necessary to my comfort or to alleviate pain.
Initial: follow the instructions of ______________________________ whom I appoint as my Health Care Proxy to decide whether life-sustaining treatment should be withheld or withdrawn.
Permanent Unconsciousness
If I should become permanently unconscious, I direct my attending physician, pursuant to the Arkansas Rights of the Terminally Ill or Permanently Unconscious Act, to:
Initial ONE alternative:
Initial: withhold or withdraw life-sustaining treatments that are no longer necessary to my comfort or to alleviate pain.
Initial: follow the instructions of ______________________________ whom I appoint as my health care proxy to decide whether life-sustaining treatment should be withheld or withdrawn.
Specific Directives
Initial each directive that applies. Do not select both “may be withheld” and “may not be withheld” for the same item.
Initial: It is my specific directive that nutrition may be withheld after consultation with my attending physician.
Initial: It is my specific directive that hydration may be withheld after consultation with my attending physician.
Initial: It is my specific directive that nutrition may not be withheld.
Initial: It is my specific directive that hydration may not be withheld.
Important Arkansas-Law Notes
Execution. Sign personally, or have another sign at your direction, and complete EITHER notarization (no witnesses are needed for a declaration executed on or after July 1, 2017) or the two-witness alternative. Ark. Code § 20-17-202(a).
Comfort care. The Act does not affect the duty to provide treatment, nutrition, or hydration necessary for comfort or to alleviate pain. Ark. Code § 20-17-206(b).
PREGNANCY. A declaration of a qualified patient known to be pregnant is not given effect while the fetus could develop to live birth with continued life-sustaining treatment. Ark. Code § 20-17-206(c).
This declaration is clear and convincing evidence of my wishes. A physician or health-care provider furnished a copy shall make it part of my medical record. Ark. Code § 20-17-202(d), (f).
Execution
Complete EITHER the Two-Witness Alternative OR the Notary Acknowledgment Alternative. Do not complete both.
Date: __________________________
Declarant’s printed name: ____________________________________________________
Declarant’s signature: _______________________________________________________
Declarant’s address: ___________________________________________________________
Two-Witness Alternative
Witness 1: I am a competent adult who is not named as a healthcare proxy in this document. I witnessed the patient's signature on this form.
Witness 1 printed name: ___________________________________________________
Witness 1 address: ________________________________________________________
Witness 1 signature: ______________________________________________________
Witness 2: I am a competent adult who is not named as a healthcare proxy in this document. I am not related to the patient by blood, marriage, or adoption and I would not be entitled to any portion of the patient's estate upon his or her death under any existing will or codicil or by operation of law. I witnessed the patient's signature on this form.
Witness 2 printed name: ___________________________________________________
Witness 2 address: ________________________________________________________
Witness 2 signature: ______________________________________________________
Notary Acknowledgment Alternative
State of ________________________________
County of ________________________________
Acknowledged before me on _______________________ by __________________________.
Notary public’s printed name: ________________________________________________
Notary public’s signature: __________________________________________________
My commission expires: __________________________________
ARKANSAS DURABLE POWER OF ATTORNEY
FOR HEALTH CARE
PUBLICLEGAL FORM 1918-B · REV. 08/2026
Executed under the Arkansas Healthcare Decisions Act (Ark. Code § 20-6-101 et seq.)
Principal’s full name: _________________________________________________________
Appointment of Health Care Agent
I appoint the following person as my agent to make health care decisions for me:
Agent name: ___________________________________________________________
Address: ___________________________________________________________
Phone: _______________________________________
If that person is unable or unwilling to serve, I appoint:
Alternate agent name: ___________________________________________________________
Address: ___________________________________________________________
Phone: _______________________________________
Grant of Authority
My agent may make any health care decision I could make, including consenting to, refusing, or withdrawing consent to any care, treatment, service, or procedure. My agent may access, inspect, copy, and disclose my medical records as needed to act for me.
Federal HIPAA authorization. I designate my agent as my personal representative under 45 C.F.R. § 164.502(g), with authority to receive protected health information needed to make or carry out health care decisions.
When This Power Becomes Effective
Initial ONE:
Initial: When a determination is made that I lack capacity (the statutory default under Ark. Code § 20-6-103(d)).
Initial: Immediately. Even then, I retain the right to make my own health care decisions while I have capacity. Ark. Code § 20-6-112.
Optional Individual Instructions
State any instructions or limits below. Attach and identify another page if needed. Living-will instructions may be subject to the comfort-care and pregnancy limits in Ark. Code § 20-17-206.
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Agent’s Decision Standard
My agent shall follow my individual instructions and other wishes known to the agent. Otherwise, the agent shall act in my best interest, considering my personal values to the extent known. Ark. Code § 20-6-103(f).
If a capacity determination is necessary, it shall be made by a licensed physician. Ark. Code § 20-6-103(e).
Important Arkansas-Law Note
The Arkansas Board of Health adopted advance-directive forms in 2013, but Arkansas law permits a compliant form of one’s own choosing. This document is independently prepared and is not an official state form.
Execution
Complete EITHER the Notary Acknowledgment Alternative OR the Two-Witness Alternative. Do not complete both.
Date: __________________________
Principal’s printed name: ____________________________________________________
Principal’s signature: _______________________________________________________
Principal’s address: ___________________________________________________________
Notary Acknowledgment Alternative
State of ________________________________
County of ________________________________
Acknowledged before me on _______________________ by __________________________.
Notary public’s printed name: ________________________________________________
Notary public’s signature: __________________________________________________
My commission expires: __________________________________
Two-Witness Alternative
ATTESTATION CLAUSE: We attest that each of us is a competent adult and is not the agent named in this directive. At least one of us is not related to the principal by blood, marriage, or adoption and would not be entitled to any portion of the principal’s estate upon death under any will or codicil existing at execution or by operation of law. We witnessed the principal sign this directive. Ark. Code § 20-6-103(c).
Witness 1 printed name: ___________________________________________________
Witness 1 address: ________________________________________________________
Witness 1 signature: ______________________________________________________
Witness 2 printed name: ___________________________________________________
Witness 2 address: ________________________________________________________
Witness 2 signature: ______________________________________________________
Legal currency, verified
This two-instrument Arkansas packet records treatment wishes and appoints a trusted health care decision-maker under Ark. Code §§ 20-17-202 and 20-6-103.
The declaration substantially tracks both statutory condition forms and their four nutrition and hydration directives. The companion power of attorney is independently prepared under the Arkansas Healthcare Decisions Act.
The download includes the Arkansas Living Will Declaration and a separate Durable Power of Attorney for Health Care, each in editable Word and true fillable PDF, plus one combined completed sample.
Execute each instrument separately by completing either its notary alternative or its two-witness alternative—not both. The witnessed power of attorney includes the attestation clause required by Ark. Code § 20-6-103(c)(3). You may complete either or both instruments.
This form is not legal advice and does not replace advice from an Arkansas attorney about your circumstances.
ILRG is committed to top quality legal forms that are valid in all states. If you are not 100 percent satisfied after purchase, contact us for a full refund.
Yes. The declaration tracks both statutory forms in Ark. Code § 20-17-202(b) (terminal condition) and (c) (permanently unconscious), including the four nutrition-and-hydration directives, and the power of attorney follows the Arkansas Healthcare Decisions Act. Reviewed and verified against current Arkansas law in August 2026.
For each instrument, choose one path: acknowledge your signature before a notary public, or sign before two qualified witnesses. Do not complete both. If you use witnesses for the power of attorney, the attestation clause Ark. Code § 20-6-103(c)(3) requires is printed in the form for them to sign.
Two situations, which you may complete separately or together: a terminal condition, and permanent unconsciousness. For each, you direct whether life-sustaining treatment is provided or withheld, and you initial one of the four statutory directives about artificially supplied nutrition and hydration.
The living will states your wishes for end-of-life treatment. The durable power of attorney appoints the person who makes health care decisions for you whenever you cannot, including situations your declaration does not address. Each instrument is executed separately with its own notary-or-two-witnesses path.
Both contain the same document text. Use the editable Word (.docx) files to type in your details, or the fillable PDFs to complete the forms on screen. Either way, print the finished documents, initial your elections, and sign before your notary or witnesses, initials and signatures belong on paper.