Member Forms

Looking for an advance directive or other form? You can download any of the forms below at no cost.

Living wills and other advance directives

It is important for everyone to plan for end of life care. Even if you are not sick or injured now, you should consider what kind of care you would want if you were. What if you were unable to express your wishes?

Advance directives are documents that protect your right to request health care you do want, or to refuse health care you do not want. Click on the links below to get more information that can help you arrange for your wishes to be honored. The Arizona Attorney General's office also has information that can help.

Living Will

A living will is a legal document that tells others your wishes for life-sustaining measures. These might include:

  • Breathing machines
  • Tube feeding
  • Resuscitation if your breathing or heartbeat stops
  • Dialysis

You can choose to accept or refuse this type of care in advance, by writing it into your living will.

A living will may also tell others whether you want to be an organ donor.

This document is not a legal opinion. Members should review their advance directives with a lawyer to verify that they are properly prepared. Aetna is not responsible for the information available on the Attorney General’s website, or for updating information about changes to the law affecting advance directives.

Download a Living Will Form.

Medical Power of Attorney (POA)

A Medical POA is a legal document that names your health care proxy. A health care proxy is a person you trust to make health care decisions for you if you are unable to do it for yourself.

This is different from a POA that gives someone else the ability to make financial decisions for you. Sometimes it is also called a durable POA for health care.

This document is not a legal opinion. Members should review their advance directives with a lawyer to verify that they are properly prepared. Aetna is not responsible for the information available on the Attorney General’s website, or for updating information about changes to the law affecting advance directives.

Download a Medical POA Form.

Mental Health Care Power of Attorney (POA)

A Mental Health Care POA Form is a document that names a person to make mental health care decisions if you are found to be incapable of doing so.

This document is not a legal opinion. Members should review their advance directives with a lawyer to verify that they are properly prepared. Aetna is not responsible for the information available on the Attorney General’s website, or for updating information about changes to the law affecting advance directives.

Download a Mental Health Care POA Form.

Pre-Hospital Medical Directive

Pre-Hospital Medical Care states your wishes about refusing certain life-saving emergency care given outside a hospital or in a hospital emergency room. You must complete a special orange form.

This document is not a legal opinion. Members should review their advance directives with a lawyer to verify that they are properly prepared. Aetna is not responsible for the information available on the Attorney General’s website, or for updating information about changes to the law affecting advance directives.

Download a Pre-Hospital Medical Care Directive Form.

For both a Living Will and a Medical Power of Attorney, you must choose someone to be your agent. Your agent is the person who will make decisions about your health care if you cannot. For example, he/she can be a family member or a close friend. Download a Letter to My Agent (Representative) form.

In Arizona, an Advance Directive must be:

1. Signed and dated in front of another person who also signs it. This person cannot:

  • Be related to you by blood, marriage or adoption
  • Be under 18
  • Have a right to receive any of your estate (personal and private property) by will or under law at the time this is signed
  • Be appointed as your agent
  • Be involved with the paying of or providing any of your health care
  • Be designated (chosen) to make medical decisions on your behalf

OR

2. Signed and dated in front of a notary public. The notary public cannot be your agent or any person involved with the paying of your health care.

After you complete your Advance Directives:

  1. Keep your original signed papers in a safe place.
  2. Give copies of the signed papers to your doctor(s), hospital and anyone else who might become involved in your health care. Talk to these people about your wishes about health care.
  3. If you want to change your papers after you have signed them, you must complete new papers. You should make sure you give a copy of the new paper to all the people who already have a copy of the old one.
  4. For information about registering your advance directives with the Arizona Registry, please go to www.azsos.gov/adv_dir

Support and Education Groups

Arizona End of Life Partnership

Most people find it difficult to talk about death. Our mission is to enhance the way we live by fundamentally changing the way we talk about death. Our community partners provide support, services, and education to help you talk about what’s important to you so that you can live well and end well.  For information, please visit www.azendoflifecare.org.

Mileage/Food Reimbursement Form