Arizona Health Care Power of Attorney

This is a list of the information that will be entered in the form, which you can gather before you begin.

1. Your Personal Information
• Your Name
• Your date of birth
• Your current residence address
2. Agents
   • You must select an Agent (or attorney in fact) and should select an alternate Agent to carry out your wishes under your Health Care Power of Attorney
   • Name and residence address of the primary and alternate Agents.
3. Authority
• You must choose the type of authority to be granted to the agents.