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Revocation Of Advance Health Care Directive (Arizona) POA-AZ 100 - Legal Forms
| Revocation Of Advance Health Care Directive (Arizona) Form. This is a Legal Forms form and can be used in Health Care-Living Wills Power Of Attorney . |
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ARIZONA-REVOCATION OF ADVANCE HEALTH CARE DIRECTIVE Title 36 Public Health and Safety - Section 36-3202 I, , Declarant, having executed a Advance Health Care Directive regarding certain choices and decisions that I had made relating to my healthcare to my agent who shall be empowered to make health care decisions appropriately on behalf of me, the Declarant on the day of 20 . Pursuant to Arizona Revised Statutes §36-3202, a person may revoke his own health care directive by doing any of the following: 1. Making a written revocation of a health care directive or a written statement to disqualify a surrogate. 2. Orally notifying the surrogate or a health care provider. 3. Making a new health care directive. 4. Any other act that demonstrates a specific intent to revoke or to disqualify a surrogate. Revocation: I hereby revoke my healthcare directive dated of 20 , in a form of written revocation which was signed and dated by me, the declarant/the person acting at the direction of the declarant. I am providing a copy of this revocation to all parties to whom I provided a copy of the original directive. DATED this day of Signature of Declarant: Printed Name of Declarant: Address of Declarant: , 20 . American LegalNet, Inc. © www.FormsWorkFlow.com
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