Free Arkansas Medical Power of Attorney Form | PDF

Arkansas Medical Power of Attorney Form

An Arkansas Medical Power of Attorney authorizes an agent to call the shots regarding health care procedures for an individual who has become incapacitated. For this to be achieved, the document must be executed while the principal is still sound of mind. It works as a backup plan if the primary party ever loses communication ability.

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Last updated February 26th, 2026

An Arkansas Medical Power of Attorney authorizes an agent to call the shots regarding health care procedures for an individual who has become incapacitated. For this to be achieved, the document must be executed while the principal is still sound of mind. It works as a backup plan if the primary party ever loses communication ability.

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Statutes – Arkansas Code – Arkansas Healthcare Decisions Act (§ 20-6-101 – 20-6-118)

Definitions – “Durable power of attorney for health care”:

(A) Means a written advance directive that identifies an agent who is authorized to make healthcare decisions on behalf of the principal.
(B) Includes without limitation a document appointing a healthcare proxy executed under § 20-17-202 (§ 20-6-102(4)).

Signing Requirements – Must be signed by the principal in the presence of a notary public or two (2) witnesses (§ 20-6-103(c)(1)).

Revocation – § 20-6-104

Other Versions (5)

Arkansas Bar Assoc.
Arkansas Law Help
Baptist Health
JRMC Version
UA for Medical Sciences Version

Arkansas Bar Association Version

Download: Adobe PDF

Arkansas Law Help Version

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Baptist Health Version

Download: Adobe PDF

Jefferson Regional Medical Center Version

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University of Arkansas for Medical Sciences Version

Download: Adobe PDF

Additional Resources

Arkansas Dept. of Health – POLST Information
Arkansas Hospice – Advanced Care Plans
Baptist Health – Living Will and Advanced Directive
Christus Health – Advance Care Planning
University of Arkansas for Medical Sciences – Advance Medical Directives

Related Forms (7)

Acceptance of Surrogate
Advance Directive
Advance Directive Wallet Card
Durable (Financial) Power of Attorney Form
EMS DNR Form
Living Will
POLST Form

Acceptance of Surrogate

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Advance Directive

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Advance Directive Wallet Card

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Durable (Financial) Power of Attorney

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Emergency Medical Services Do-Not-Resuscitate Order

Download: Adobe PDF

Living Will

Download: Adobe PDF

Physician Orders for Life-Sustaining Treatment (POLST)

Download: Adobe PDF

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