Healthy Communities

HealthCare Decision Forms

Below are the Health Care Decision Forms that were adopted by the Board of Health on October 24, 2013 pursuant to the Health Care Decisions Act (Act 1264 of 2013).

Downloads
Acceptance of Surrogate Form
Advance Care Plan Form
Appointment of Health Care Agent Form

Act 504 of 2017 Arkansas Physician Order for Life-Sustaining Treatment Act (POLST) provides a standardized physician order form. The links below include the standardized physician order form and helpful directions for completing the order form.

Resources
Physician Orders for Life Sustaining Treatment

Public Health Accrediation Board
Arkansas Department of Health
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4815 W. Markham, Little Rock, AR 72205-3867 | 1-800-462-0599