Download Life Care Planning Packet PDF

TitleLife Care Planning Packet
LanguageEnglish
File Size2.0 MB
Total Pages137
Document Text Contents
Page 1

A guide to advise individuals, families and caregivers about
different legal options for adults with a disability who need

assistance—all with a goal of preserving as many rights as possible

Third Edition: October 2016 - Not for Individual Sale

Legal Options
Manual

Page 2

This manual was developed for the
Arizona Developmental Disabilities Planning

Council by the
Arizona Center for Disability Law,

the Native American Disability Law Center and
Leigh Bernstein, Esq.

This is not intended as a substitute
for legal advice.

Federal and state law can change at any time.
Please be sure to check current law for any

changes.

Copyright © 2012 Arizona Developmental Disabilities
Planning Council

All rights reserved.

Page 68

Office of the Attorney General of Arizona, Mark Brnovich
Life Care Planning Packet: Durable Mental Health Care Power of Attorney

Sec. 4: Page 12 of 17 Updated 06/16

time.

Witness Name (printed):
___________________________

Signature:
______________________________________

Date:
______________________________________

SIGNATURE OF WITNESS OR NOTARY PUBLIC

NOTE: At least one adult witness OR a Notary
Public must witness the signing of this
document and then sign it. The witness or
Notary Public CANNOT be anyone who is: (a)
under the age of 18; (b) related to you by blood,
adoption, or marriage; (c) entitled to any part of
your estate; (d) appointed as your
representative; or (e) involved in providing your
health care at the time this document is signed.

Page 69

Office of the Attorney General of Arizona, Mark Brnovich
Life Care Planning Packet: Durable Mental Health Care Power of Attorney

Sec. 4: Page 13 of 17 Updated 06/16

A. Witness: I affirm that I personally know the

person signing this Durable Mental Health Care

Power of Attorney and that I witnessed the

person sign or acknowledge the person's

signature on this document in my presence. I

further affirm th at he/she appears to be of sound

mind and not under duress, fraud, or undue

influence. He/she is not related to me by blood,

marriage, or adoption and is not a person for

whom I directly provide care in a professional

capacity. I have not been appointed to make

medical decisions on his/her behalf.

Witness Name

(printed): ________________________________

Signature: _________________________________

Date:_____________________________________

Page 137

(602) 542-8970 | Toll Free: (877) 665-3176
addpc.az.gov

3839 N. 3rd Street, Suite 306, Phoenix, AZ 85012

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