To complete the Arkansas advance directive form, download the free Advance Care Plan from the Arkansas Department of Health, fill in your health care agent, your treatment preferences, and any optional sections like organ donation, then sign the document in front of either two qualifying witnesses or a notary public. The form combines a living will and a durable power of attorney for health care into one document under the Arkansas Healthcare Decisions Act, Arkansas Code § 20-6-101 through § 20-6-118. Any adult, married minor, or emancipated minor can execute one, and no attorney is required.
What the Form Actually Does
The Arkansas Advance Care Plan bundles two legal tools. The living will portion records your instructions about life-sustaining treatment if you reach a point where recovery is not expected. The durable power of attorney portion names a health care agent who can make medical decisions for you when you cannot make them yourself.
Under Arkansas Code § 20-6-103, your agent’s authority begins only when a physician determines you lack capacity to decide for yourself, and it ends if you regain that capacity.1Justia. Arkansas Code 20-6-103 – Oral or Written Individual Instructions – Advance Directive for Health Care The living will gives your agent a roadmap. The power of attorney gives them the legal standing to act when the roadmap runs out. You can complete both sections or just one.
Decisions to Make Before You Start
The biggest decision is who to name as your health care agent. Pick someone you trust to follow your wishes even under pressure from other family members or physicians. The form also asks for an alternate agent who steps in if your first choice is unavailable or unwilling to serve.2Arkansas Department of Health. Arkansas Advance Care Plan Form
For each agent, you will need their full legal name, mailing address, phone number, and relationship to you. Use names exactly as they appear on government identification.
Arkansas law does not restrict who can serve. There is no prohibition on naming a friend or a neighbor. Avoid naming your treating physician, since that creates a clear conflict of interest.
Think through your treatment preferences before you start writing. The form asks you to say yes or no to specific interventions, and having that conversation with your doctor or your agent first makes the answers more honest than checking boxes cold.
Where to Get the Form
The official Arkansas Advance Care Plan form is available as a free PDF from the Arkansas Department of Health.2Arkansas Department of Health. Arkansas Advance Care Plan Form It walks you through each section with plain-language explanations and includes the attestation language your witnesses will sign, so you do not need to assemble anything separately.
Filling Out Each Section
Naming Your Agents
The first section asks you to designate a primary health care agent and an alternate. Fill in each person’s name, address, phone number, and their relationship to you.
Treatment Preferences
The core of the living will section asks you to indicate yes or no for each major category of life-sustaining treatment:
- CPR (cardiopulmonary resuscitation): electric shock, chest compressions, and breathing assistance to restart the heart and lungs after they stop.
- Life support and artificial support: continuous use of a breathing machine, IV medications, and other equipment that keeps organs functioning.
- Tube feeding and IV fluids: delivery of food and water through a feeding tube to the stomach or through an IV line into a vein.
The form includes space for additional instructions covering anything the checkboxes do not. If you have strong feelings about pain management, comfort-only care, or specific scenarios like a persistent vegetative state, write them here in your own words. Be concrete. “I don’t want to be kept alive on machines” is less useful to your agent than “If two physicians agree I have no reasonable chance of recovering awareness, discontinue mechanical ventilation and provide comfort care only.”
Organ Donation
An optional section lets you indicate whether you want to donate organs or tissues after death. You can choose to donate any organ or tissue, your entire body, or only specific organs you list. Leaving this section blank does not prevent donation. It simply means the decision falls to your family or agent.2Arkansas Department of Health. Arkansas Advance Care Plan Form
Signing the Form
Arkansas gives you two options for making the document legally binding. You can have it witnessed by two adults, or you can have it notarized. You do not need both.1Justia. Arkansas Code 20-6-103 – Oral or Written Individual Instructions – Advance Directive for Health Care
If you choose witnesses, the rules are:
- Both witnesses must be competent adults.
- Neither witness can be the person you named as your health care agent.
- At least one witness must not be related to you by blood, marriage, or adoption and must not stand to inherit any portion of your estate under your will or state intestacy law.
- The form must include an attestation clause, meaning a statement the witnesses sign confirming they meet these requirements. The Arkansas Department of Health form has this built in.
If you choose notarization instead, a notary public verifies your identity, confirms you appear to be of sound mind and acting without coercion, and applies their seal. This route is simpler in some ways because you do not need to find two qualifying witnesses, but it does require a trip to a notary.
Some people do both for extra security. That is fine but not legally necessary. One or the other satisfies the statute. Getting this step right matters: a directive that fails execution requirements may be unenforceable when it is needed most.
What to Do After Signing
A perfectly executed advance directive sitting in a desk drawer helps no one. Distribution is the step that turns the form into something that actually protects you.
Give copies to your health care agent and your alternate agent. Deliver a copy to your primary care physician so it can be added to your permanent medical record. If you regularly receive care at a hospital or specialty clinic, provide a copy to their admissions or medical records department as well.
Keep the original in a place your agent can access quickly. A fireproof home safe works well. A bank safe-deposit box generally does not, because banks have limited hours and often require the box holder’s authorization or a court order, so your agent may not have access when you need it most.
Some residents carry a wallet card noting that an advance directive exists, along with the agent’s name and phone number. This helps in situations where you are brought to an unfamiliar emergency room. Electronic registries like the U.S. Advance Care Plan Registry store scanned copies in a secure online database that providers can access around the clock, and registrants receive wallet cards with a unique registration number that providers can use to retrieve the document by phone.3U.S. Advance Care Plan Registry. How The Registry Works
Keep a list of everyone who has a copy. When you update the directive later, you will need to distribute the new version and collect or destroy the old ones.
Changing or Revoking the Form
Under Arkansas Code § 20-6-104, you can revoke all or part of your advance directive at any time and in any manner that communicates your intent to revoke. That includes a written statement, a verbal declaration to your physician, or simply executing a new directive, which automatically supersedes an older one to the extent they conflict.4Justia. Arkansas Code 20-6-104 – Revocation of Designation of Agent – Revocation of Advance Directive – Spouse as Agent – Conflicts
A few situations are worth knowing about:
- A divorce, annulment, or legal separation automatically revokes the designation of your former spouse as agent, unless the decree or the directive itself says otherwise.
- You can revoke just the agent designation, just the living will instructions, or any other portion while leaving the rest intact.
- Any health care provider, agent, or surrogate who learns about a revocation must promptly communicate that fact to the supervising physician and any facility where you are receiving care.
If you revoke verbally while in a hospital bed, make sure the attending physician documents it in your medical record. A verbal revocation is legally valid, but it can be disputed later if no one wrote it down. The safest approach when making changes is to execute an entirely new document with fresh signatures and distribute it to everyone who holds a copy of the old one.
The Pregnancy Exclusion
Arkansas has a pregnancy exclusion in its advance directive law. Under Arkansas Code § 20-17-206, an advance directive is not effective during pregnancy if the fetus could develop to the point of live birth with continued life-sustaining treatment. Even if your directive says to withdraw life support, physicians may be legally required to continue treatment to sustain a viable pregnancy. If this issue could apply to you, discuss it with an attorney and your physician so you understand exactly how it affects your document.
Using the Form Across State Lines
If you split time between Arkansas and another state, interstate recognition of advance directives is inconsistent. Some states honor out-of-state directives as written, others honor them only if they substantially comply with local law, and some have no clear answer. The safest approach is to complete a separate advance directive for each state where you spend significant time, naming the same agent in each so there is no confusion about who speaks for you.