Arizona Secretary of State - Ken Bennett


 
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ABOUT THE REGISTRY
The Arizona Advance Directive Registry is a place to electronically store a copy of your advance directive so it will be available where and when it is needed 24/7. Access to our central database via computer helps expedite patient's health requests
.

The Arizona Advance Directive Registry is a FREE database for the storage of advance directives (Living Will, Medical Power of Attorney, and Mental Health Power of Attorney).

Free Guide Explains Advance Directives Program

Download our free Guide to Filing Advance Directives with our office. Requires Adobe Acrobat Reader
Request the Guide to Filing Advance Directives by mail.

Quick Facts

  • The Arizona Secretary of State oversees Registry filings, its security, and operations.
  • Participants and their loved ones may use the Registry to look up registered directives.
  • Heath care providers may use the Registry to look up registered directives using the information provided to them by the participant.
  • The Arizona Advance Directive Registry was created in May 2004 by the Arizona State Legislature.
How do I get started to participate in this program?
Prepare an Advance Directive
  • Choose and prepare an Advance Directive to file.
  • The Directive can be a Living Will, Medical Power of Attorney, or Mental Health Power of Attorney or a combination of the three.
  • Information about life care planning is available from the Arizona Attorney General's Office. Forms are included on the AG's website.
  • If you do not feel comfortable in preparing a Directive contact an attorney.
  • Once you have completed your Advance Directive, make sure it is properly signed by a witness or notarized.
Register your Advance Directive with us
  • Complete the Registration Agreement and return it to our office with your Advance Directive.
  • There are no fees for this service.
  • There is no "online" registration. A copy of the Advance Directive must be mailed to the office.

Instructions to register an Advance Directive

    1. Print a copy of the Registration Agreement
            This form is in pdf. Requires a free Adobe Acrobat Reader.

    2. Read the Registration Agreement carefully, and complete the form.

    3. Attach a COPY of your witnessed or notarized Advance Directive to the Registration Agreement.

    Do not send your original advance directive forms.

    The copy of your advance directive forms must be legible and clearly readable.

    4. Sign and date the Registration Agreement and return it by mail to:

    Arizona Advance Directive Registry
    Arizona Secretary of State
    1700 W. Washington Street – 7th Floor
    Phoenix, AZ 85007

    If you would like to file the Registration Agreement and Advance Directive in person visit our Customer Service Center.

Verification Process of Registration

    1. A printed record of the registration will be returned by mail and a wallet card will be issued. Review both for accuracy.

    • If the information is accurate check the box "no corrections required"
    • If the information is inaccurate check the box "the information is not correct"

    2. Sign the confirmation form and return it to the Secretary of State's Office.

    3. If needed the Secretary of State's Office will make corrections as specified by the program participant.

    The Secretary of State's Office will not activate your registration until a verification form marked "no corrections" required is recevied.

Activation of Registration

    1. Once the office receives verification that the information on file is correct the registration is officially activated.

    2. Keep the wallet card with file number and password handy.

Contact Your Health Care Provider

    Share your password with your appointed medical power of attorney, with your doctor and the hospital or clinic where you receive medical care.

Thank you for your interest in Arizona’s Advance Directive Registry.

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Program Participants
Log in to View Your Advance Directive

 
 
 

If you have questions, please contact the Office of the Arizona Secretary of State:

Email: Email Us
Phone: 602-542-6187
Toll Free: 800-458-5842

Arizona Secretary of State
Advance Directives
1700 W. Washington, 7th Floor
Phoenix, AZ 85007

 
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