The California Advanced Health Care Directive form is a legal document that allows individuals to outline their preferences for medical treatment in the event they are unable to communicate their decisions. It serves as a guide for healthcare professionals and loved ones, ensuring that a person's healthcare wishes are known and respected. To secure your healthcare preferences and ensure your voice is heard even when you cannot speak for yourself, consider filling out this form by clicking the button below.
In California, the Advanced Health Care Directive form stands as a crucial document that allows individuals to outline their medical care preferences in the event that they become unable to make decisions for themselves. This significant piece of paper is a combination of what was formerly known as a living will and a durable power of attorney for health care, bringing both concepts together into a single, comprehensive document. It empowers you to appoint a trusted person, often referred to as a health care agent or proxy, to make health care decisions on your behalf if you are incapacitated. Furthermore, the form enables individuals to specify their wishes regarding various types of life-sustaining treatments, organ donation, and other critical end-of-life decisions. The versatility of the form means that it can be tailored to reflect one's personal values, religious beliefs, and specific medical preferences, ensuring that their health care treatment aligns with their wishes, even when they are not able to communicate. This proactive step not only provides peace of mind to the individual but also offers clear guidance to families and healthcare providers, potentially easing the burden during challenging times.
ADVANCE HEALTH CARE DIRECTIVE FORM
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Probate Code - PROB
DIVISION 4.7. HEALTH CARE DECISIONS [4600 - 4806] ( Division 4.7 added by Stats. 1999, Ch. 658, Sec. 39. ) PART 2. UNIFORM HEALTH CARE DECISIONS ACT [4670 - 4743] ( Part 2 added by Stats. 1999, Ch. 658, Sec. 39. )
CHAPTER 2. Advance Health Care Directive Forms [4700 - 4701] ( Chapter 2 added by Stats. 1999, Ch. 658, Sec. 39. )
4701. The statutory advance health care directive form is as follows:
ADVANCE HEALTH CARE DIRECTIVE
(California Probate Code Section 4701)
Explanation
You have the right to give instructions about your own health care. You also have the right to name someone else to make health care decisions for you. This form lets you do either or both of these things. It also lets you express your wishes regarding donation of organs and the designation of your primary physician. If you use this form, you may complete or modify all or any part of it. You are free to use a different form.
Part 1 of this form is a power of attorney for health care. Part 1 lets you name another individual as agent to make health care decisions for you if you become incapable of making your own decisions or if you want someone else to make those decisions for you now even though you are still capable. You may also name an alternate agent to act for you if your first choice is not willing, able, or reasonably available to make decisions for you. (Your agent may not be an operator or employee of a community care facility or a residential care facility where you are receiving care, or your supervising health care provider or employee of the health care institution where you are receiving care, unless your agent is related to you or is a coworker.)
Unless the form you sign limits the authority of your agent, your agent may make all health care decisions for you. This form has a place for you to limit the authority of your agent. You need not limit the authority of your agent if you wish to rely on your agent for all health care decisions that may have to be made. If you choose not to limit the authority of your agent, your agent will have the right to:
(a)Consent or refuse consent to any care, treatment, service, or procedure to maintain, diagnose, or otherwise affect a physical or mental condition.
(b)Select or discharge health care providers and institutions.
(c)Approve or disapprove diagnostic tests, surgical procedures, and programs of medication.
(d)Direct the provision, withholding, or withdrawal of artificial nutrition and hydration and all other forms of health care, including cardiopulmonary resuscitation.
(e)Donate your organs, tissues, and parts, authorize an autopsy, and direct disposition of remains.
Part 2 of this form lets you give specific instructions about any aspect of your health care, whether or not you appoint an agent. Choices are provided for you to express your wishes regarding the provision, withholding, or withdrawal of treatment to keep you alive, as well as the provision of pain relief. Space is also provided for you to add to the choices you have made or for you to write out any additional wishes. If you are satisfied to allow your agent to determine what is best for you in making end-of-life decisions, you need not fill out Part 2 of this form.
Part 3 of this form lets you express an intention to donate your bodily organs, tissues, and parts following your death.
Part 4 of this form lets you designate a physician to have primary responsibility for your health care.
After completing this form, sign and date the form at the end. The form must be signed by two qualified witnesses or acknowledged before a notary public. Give a copy of the signed and completed form to your physician, to any other health care providers you may have, to any health care institution at which you are receiving care, and to any health care agents you have named. You should talk to the person you have named as agent to make sure that he or she understands your wishes and is willing to take the responsibility.
You have the right to revoke this advance health care directive or replace this form at any time.
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PART 1
POWER OF ATTORNEY FOR HEALTH CARE
(1.1) DESIGNATION OF AGENT: I designate the following individual as my agent to make health care decisions for me:
(name of individual you choose as agent)
(address)
(city)
(state)
(ZIP Code)
(home phone)
(work phone)
OPTIONAL: If I revoke my agent's authority or if my agent is not willing, able, or reasonably available to make a health care decision for me, I designate as my first alternate agent:
(name of individual you choose as first alternate agent)
OPTIONAL: If I revoke the authority of my agent and first alternate agent or if neither is willing, able, or reasonably available to make a health care decision for me, I designate as my second alternate agent:
(name of individual you choose as second alternate agent)
(1.2) AGENT'S AUTHORITY: My agent is authorized to make all health care decisions for me, including decisions to provide, withhold, or withdraw artificial nutrition and hydration and all other forms of health care to keep me alive, except as I state here:
(Add additional sheets if needed.)
(1.3) WHEN AGENT'S AUTHORITY BECOMES EFFECTIVE: My agent's authority becomes effective when my primary physician determines that I am unable to make my own health care decisions unless I mark the following box.
If I mark this box , my agent's authority to make health care decisions for me takes effect immediately.
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(1.4.) AGENT'S OBLIGATION: My agent shall make health care decisions for me in accordance with this power of attorney for health care, any instructions I give in Part 2 of this form, and my other wishes to the extent known to my agent. To the extent my wishes are unknown, my agent shall make health care decisions for me in accordance with what my agent determines to be in my best interest. In determining my best interest, my agent shall consider my personal values to the extent known to my agent.
(1.5) AGENT'S POSTDEATH AUTHORITY: My agent is authorized to donate my organs, tissues, and parts, authorize an autopsy, and direct disposition of my remains, except as I state here or in Part 3 of this form:
:
(1.6) NOMINATION OF CONSERVATOR: If a conservator of my person needs to be appointed for me by a court, I nominate the agent designated in this form. If that agent is not wiling, able, or reasonably available to act as conservator, I nominate the alternate agents whom I have named, in the order designated.
PART 2
INSTRUCTIONS FOR HEALTH CARE
If you fill out this part of the form, you may strike any wording you do not want.
(2.1) END-OF-LIFE DECISIONS: I direct that my health care providers and others involved in my care provide, withhold, or withdraw treatment in accordance with the choice I have marked below:
(a) Choice Not to Prolong Life
I do not want my life to be prolonged if (1) I have an incurable and irreversible condition that will result in my death within a relatively short time, (2) I become unconscious and, to a reasonable degree of medical certainty, I will not regain consciousness, or (3) the likely risks and burdens of treatment would outweigh the expected benefits, OR
(b) Choice to Prolong Life
I want my life to be prolonged as long as possible within the limits of generally accepted health care standards.
(2.2) RELIEF FROM PAIN: Except as I state in the following space, I direct that treatment for alleviation of pain or discomfort be provided at all times, even if it hastens my death:
(2.3) OTHER WISHES: (If you do not agree with any of the optional choices above and wish to write your own, or if you wish to add to the instructions you have given above, you may do so here.) I direct that:
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PART 3
DONATION OF ORGANS, TISSUES, AND PARTS AT DEATH
(OPTIONAL)
(3.1)
Upon my death, I give my organs, tissues, and parts (mark box to indicate yes).
By checking the box above, and notwithstanding my choice in Part 2 of this form, I authorize my agent to consent to any temporary medical procedure necessary solely to evaluate and/or maintain my organs, tissues, and/or parts for purposes of donation.
My donation is for the following purposes (strike any of the following you do not want):
(a)Transplant
(b)Therapy
(c)Research
(d)Education
If you want to restrict your donation of an organ, tissue, or part in some way, please state your restriction on the following lines:
If I leave this part blank, it is not a refusal to make a donation. My state-authorized donor registration should be followed, or, if none, my agent may make a donation upon my death. If no agent is named above, I acknowledge that California law permits an authorized individual to make such a decision on my behalf. (To state any limitation, preference, or instruction regarding donation, please use the lines above or in Section 1.5 of this form).
PART 4
PRIMARY PHYSICIAN
(4.1) I designate the following physician as my primary physician:
(name of physician)
(phone)
OPTIONAL: If the physician I have designated above is not willing, able, or reasonably available to act as my primary physician, I designate the following physician as my primary physician:
PART 5
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(5.1) EFFECT OF COPY: A copy of this form has the same effect as the original.
(5.2) SIGNATURE: Sign and date the form here:
(date)
(sign your name)
(print your name)
(city) (state)
(5.3) STATEMENT OF WITNESSES: I declare under penalty of perjury under the laws of California (1) that the individual who signed or acknowledged this advance health care directive is personally known to me, or that the individual's identity was proven to me by convincing evidence (2) that the individual signed or acknowledged this advance directive in my presence, (3) that the individual appears to be of sound mind and under no duress, fraud, or undue influence, (4) that I am not a person appointed as agent by this advance directive, and (5) that I am not the individual's health care provider, an employee of the individual's health care provider, the operator of a community care facility, an employee of an operator of a community care facility, the operator of a residential care facility for the elderly, nor an employee of an operator of a residential care facility for the elderly.
First witness
Second witness
(print name)
(city)(state)
(signature of witness)
(5.4) ADDITIONAL STATEMENT OF WITNESSES: At least one of the above witnesses must also sign the following declaration:
I further declare under penalty of perjury under the laws of California that I am not related to the individual executing this advance health care directive by blood, marriage, or adoption, and to the best of my knowledge, I am not entitled to any part of the individual's estate upon his or her death under a will now existing or by operation of law.
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PART 6
SPECIAL WITNESS REQUIREMENT
(6.1) The following statement is required only if you are a patient in a skilled nursing facility--a health care facility that provides the following basic services: skilled nursing care and supportive care to patients whose primary need is for availability of skilled nursing care on an extended basis. The patient advocate or ombudsman must sign the following statement:
STATEMENT OF PATIENT ADVOCATE OR OMBUDSMAN
I declare under penalty of perjury under the laws of California that I am a patient advocate or ombudsman as designated by the State Department of Aging and that I am serving as a witness as required by Section 4675 of the Probate Code.
(Amended by Stats. 2018, Ch. 287, Sec. 1. (AB 3211) Effective January 1, 2019.)
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ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California,
County of
On
before me,
(insert name and title of officer)
personally appeared
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person
(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Signature
(SEAL)
Completing the California Advanced Health Care Directive form is a thoughtful step towards ensuring one's health care preferences are respected, especially during times when they may not be able to communicate their wishes directly. This legal document allows individuals to designate an agent to make health care decisions on their behalf and to specify the types of medical treatment they do or do not want to receive. The process of filling out this form requires careful consideration of one's values, choices, and the trusted individuals in their life. Following a systematic approach to fill out this form can make this reflective process more manageable.
Directives contained within this document offer guidance for your health care team and loved ones, potentially easing decision-making burdens during stressful times. It is advisable to review and update this document periodically, especially after any significant life changes. By taking these steps, you can ensure that your health care preferences are known, respected, and followed.
An Advanced Health Care Directive in California is a legal document that allows you to outline your wishes for medical treatment in the event that you become unable to communicate those decisions for yourself. This directive can designate an agent to make health care decisions on your behalf and can also provide specific instructions about any health care you do or do not want to receive.
Any individual over the age of 18 who wishes to have control over their medical treatment decisions should consider creating an Advanced Health Care Directive. It is especially important for those with specific wishes about their health care or those with chronic or potentially incapacitating conditions.
To appoint someone as your health care agent in California, you need to complete an Advanced Health Care Directive form. In the form, you will specify the individual you are appointing and what authority they have regarding your health care decisions. This document must be signed, dated, and either notarized or witnessed by two adults who meet specific requirements outlined by state law.
Your health care agent can make a variety of decisions on your behalf, including, but not limited to:
Yes, you have the right to revoke or change your Advanced Health Care Directive at any time, as long as you are considered of sound mind. This can be done by creating a new directive, verbally informing your health care provider, or by destroying the existing document.
Your agent is legally obligated to follow your health care instructions as outlined in your Advanced Health Care Directive. If you have provided clear instructions about specific treatments or care preferences, your agent must adhere to these wishes. However, if situations arise that were not specifically covered in your directive, your agent will use their judgment to make decisions in your best interest.
If you become incapacitated without an Advanced Health Care Directive in place, health care decisions will typically be made for you by a court-appointed guardian, your closest available relative, or a doctor, in accordance with California law. This may result in decisions that don't align with your personal beliefs or desires.
No, you do not need a lawyer to create an Advanced Health Care Directive. However, consulting with a legal professional can be beneficial to ensure that your directive clearly states your wishes and is completed in accordance with California law.
To ensure your directive is followed, provide a copy to your appointed health care agent, primary physician, and any health care facility at which you receive care. Additionally, discuss your wishes and the contents of your directive with these individuals to ensure they understand your preferences.
When filling out the California Advanced Health Care Directive form, careful attention is necessary to ensure your health care wishes are clearly communicated. Below, we highlight six common mistakes people often make:
Not picking an agent who is fully informed or willing to advocate on your behalf. Your agent should understand your healthcare preferences and be ready to enforce them, even under pressure.
Failing to discuss specific wishes with the chosen agent. It is crucial to have detailed conversations about your healthcare preferences with your agent to prevent any misunderstandings later.
Skipping over instructions related to the donation of organs or body. Many overlook this section, not realizing its importance in their healthcare directive.
Not specifying preferences for end-of-life care. This includes decisions about life support, pain management, and other critical treatments.
Forgetting to sign and date the document in front of the required witnesses or a notary, making the directive legally invalid.
Assuming one form fits all situations. Laws can vary by state, so it's important to ensure the form complies with California's specific requirements.
Avoiding these mistakes can help ensure your healthcare directives are understood and followed. Remember, completing this form is a vital step in planning for your future healthcare needs.
Completing a California Advanced Health Care Directive is a crucial step for individuals planning for their future medical care. This directive ensures that one's health care preferences are known and can be legally upheld even if they become unable to communicate them. However, to ensure a comprehensive approach to health care and estate planning, there are several other forms and documents that are often used in conjunction with this directive. Here are seven key documents that complement the Advanced Health Care Directive.
In summary, while the California Advanced Health Care Directive is pivotal for making your health care wishes known, it's only one component of a thorough legal and health care planning process. Including additional documents like a Power of Attorney for finances, a living will, and a POLST form ensures that all aspects of your care and estate are handled according to your wishes. Comprehensive planning provides peace of mind not only to you but also to your loved ones during difficult times.
Living Will: Like the California Advanced Health Care Directive, a living will allows individuals to outline their preferences for medical treatment should they become unable to communicate their wishes directly. Both documents specify the types of medical interventions a person desires or wants to avoid, such as life support and resuscitative measures, under certain health conditions.
Durable Power of Attorney for Health Care: This document is very similar to one of the components of the California Advanced Health Care Directive. It specifically designates someone, usually called a health care agent or proxy, to make medical decisions on behalf of the individual if they are incapable of making those decisions themselves. The directive incorporates this function, allowing for comprehensive planning.
Do Not Resuscitate (DNR) Order: A DNR is a doctor's order that prevents medical personnel from performing CPR if the patient's breathing stops or if the patient's heart stops beating. While a DNR is more specific and directly applicable in emergency situations, the California Advanced Health Care Directive can include preferences about such orders, making it broader in scope.
Medical Orders for Life-Sustaining Treatment (POLST): A POLST form is designed for individuals with serious health conditions and outlines specific instructions for life-sustaining treatment. While the POLST is more immediate and actionable by emergency medical personnel and other healthcare providers, the California Advanced Health Care Directive provides a broader framework for expressing one's healthcare wishes, including but not limited to life-sustaining treatments.
Five Wishes Document: Similar to the California Advanced Health Care Directive, the Five Wishes document addresses personal, spiritual, and emotional needs in addition to medical wishes towards the end of life. This document goes beyond traditional medical directives by incorporating more holistic aspects of care preferences, offering a complementary perspective to the advanced directive's approach.
Last Will and Testament: Though primarily focused on the distribution of an individual's estate after their death, a Last Will and Testament shares the conceptual underpinning of preparing for the future. Like the California Advanced Health Care Directive, it can provide peace of mind and guidance to family members during difficult times, despite its primary focus being on assets rather than healthcare decisions.
Completing the California Advanced Health Care Directive (AHCD) form is a significant step in planning for future health care decisions. It allows you to appoint someone to make health care decisions on your behalf and specify your health care wishes. To ensure your directive is effective and accurately reflects your desires, adhere to the following dos and don'ts:
Understanding the California Advanced Health Care Directive form is crucial for making informed choices about future health care preferences. However, several misconceptions can lead to confusion and hesitation in completing this important document. Clarifying these misconceptions is essential for individuals looking to take control of their health care decisions.
Only the Elderly Need It: A common misconception is that the California Advanced Health Care Directive form is only for elderly individuals. In reality, any adult over 18 can and should consider creating one. Unexpected medical situations can occur at any age, making it important to have your health care preferences documented.
It's Too Complex to Fill Out: Some people believe that completing the Advanced Health Care Directive form requires a lot of legal knowledge or assistance from a lawyer. While legal advice can be beneficial, especially in complex situations, the form is designed to be straightforward and user-friendly for the general public.
It Only Covers Life-Support Decisions: While decisions about life-support are a significant aspect, the form also allows you to express wishes about pain management, organ donation, and other end-of-life care preferences. It's a comprehensive tool for health care planning.
Once Completed, It Cannot Be Changed: Another common misunderstanding is that once the Advanced Health Care Directive form is signed, it is set in stone. In fact, you can update or revoke your directive at any time as your preferences or circumstances change.
It's the Same as a Will: People often confuse Advanced Health Care Directives with wills. However, a will handles estate and property matters after death, while an Advanced Health Care Directive focuses on your wishes for medical treatment while you are still alive but unable to speak for yourself.
It Guarantees My Wishes Will Be Followed Exactly: While the directive is legally binding and health care providers must make a reasonable effort to follow it, emergency medical situations may limit the ability to comply fully with your documented wishes. Communication with family and your health care proxy is key.
Only a Lawyer Can Help Me Complete It: It is not necessary to hire a lawyer to complete an Advanced Health Care Directive. Assistance is available through various resources, including health care providers and reputable online guides. However, for specific legal concerns or complex estates, consulting a lawyer might be advisable.
A Directive Is Only Useful If I'm Diagnosed with a Terminal Illness: This document is valuable in many situations, not just terminal illness. It covers scenarios where you might be temporarily unable to make decisions due to injury or illness, ensuring your health care preferences are known and considered.
Dispelling these misconceptions is vital for encouraging more people to take the proactive step of completing the California Advanced Health Care Directive form. By doing so, individuals can ensure their health care preferences are known and respected, no matter what the future holds.
The California Advanced Health Care Directive form is a vital document that enables individuals to specify their preferences regarding medical treatment in situations where they are unable to communicate their desires directly. Understanding how to properly complete and use this document can ensure that an individual's health care choices are respected and followed. Here are key takeaways to consider:
Understand the Parts: The California Advanced Health Care Directive consists of two main sections – the Power of Attorney for Health Care and the Individual Health Care Instructions. The former allows you to appoint a health care agent to make decisions on your behalf, while the latter lets you express your wishes about your health care.
Choosing Your Agent Wisely: It's crucial to select a trusted individual as your health care agent, someone who understands your preferences and is willing to advocate on your behalf. This person could be a family member, a friend, or anyone you trust to make health care decisions for you.
Be Specific About Your Health Care Wishes: The more specific you are in your health care instructions, the easier it will be for your health care providers and agent to follow your wishes. Consider including your thoughts on different types of treatment, such as life-sustaining treatments or palliative care.
Legal Requirements for Executing the Form: For the document to be legally valid, it must be signed in the presence of two witnesses or a notary public. The witnesses must meet certain criteria, such as not being your health care provider or the appointed health care agent.
Distribute Copies of the Document: Once the form is completed and executed, it's important to distribute copies to key individuals. These should include your health care agent, your primary physician, and close family members or friends. It might also be prudent to keep a copy in a place where it can be easily found in case of an emergency.
Proactively completing and discussing your California Advanced Health Care Directive ensures that your health care preferences are understood and considered, ultimately providing peace of mind to both yourself and your loved ones.
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