Fillable Form California Advance Health Care Directive

What is the California Advance Health Care Directive?

The California Advance Health Care Directive, or AHCD, Advance Directive, Living Will, or Medical Power of Attorney, is a legal document outlining how health care decisions should be made by your chosen person, known as the agent if you’re unable to make decisions for yourself.

You may download a PDF copy of the California Advance Health Care Directive Template from websites that offer such templates. But you may electronically fill it out on PDFRun for your convenience.

How to fill out the California Advance Health Care Directive?

Enter all necessary information in the California Advance Health Care Directive PDF. Make sure that everything you enter is true, accurate, and correct.

Part 1 - Power of Attorney for Health Care

Designation of Agent

Name of Individual you chose as Agent

Enter the full legal name of the agent.

Address, City, State, and ZIP

Enter the agent’s complete address, city, state, and ZIP.

Home Phone

Enter the agent’s home phone.

Work Phone

Enter the agent’s work phone.

This section designates an alternate agent if the agent above is unwilling or unable to make a health care decision for the principal. This section below is optional, and you may enter up to two alternate agents.

Name of Individual you chose as Agent

Enter the full legal name of the alternate agent.

Address, City, State, and ZIP

Enter the alternate agent’s complete address, city, state, and ZIP.

Home Phone

Enter the alternate agent’s home phone.

Work Phone

Enter the alternate agent’s work phone.

Agent’s Authority

Enter any exception of your agent’s authority.

When Agent’s Authority Becomes Effective

Mark the box to determine if your agent’s authority to make health care decisions for you takes effect immediately. Otherwise, leave it blank.

Agent’s Obligation

This section states that your agent shall make health care decisions for you under this power of attorney for health care, any instructions you give in Part Two of the CA Advance Health Care Directive, and other wishes to the extent known to your agent.

If your wishes are unknown, your agent shall make health care decisions for you with what your agent determines to be in your best interest. In determining your best interest, your agent shall consider your personal values to the extent known to them.

Agent’s Post Death Authority

Enter any exceptions of your agent’s post-death authority.

Part 2 - Instructions for Health Care

End-of-Life Decisions

Mark the appropriate box to determine the choice for your treatment to be done by your health care providers. You may select:

• Choice Not To Prolong Life: I do not want my life to be prolonged if:
  • I have an incurable and irreversible condition that will result in my death within a relatively short time;
  • I become unconscious and, to a reasonable degree of medical certainty, I will not regain consciousness; or
  • The likely risks and burdens of treatment would outweigh the expected benefits;
• Choice To Prolong Life:
  • I want my life to be prolonged as long as possible within the limits of generally accepted health care standards.

Relief from Pain

Enter any exceptions for the treatment provided to you for alleviation of pain or discomfort.

Other Wishes

Enter other wishes if you do not agree with any of the optional choices above.

Part 3 - Donation of Organs at Death

Mark the appropriate box to determine what organs you want to donate upon death. Take note that this part is optional. You may select:

• I give my organs, tissues, or parts; or
• I give the following organs, tissues, or parts only;
• My gift is for the following purposes:
  • Transplant
  • Therapy
  • Research
  • Education

If you marked option two, write which parts you want to donate. If you marked option three, strike any of the following options you do not want to be used for the purposes mentioned.

Part 4 - Primary Physician

This part is optional.

Name of Physician

Enter the name of your designated physician.

Address, City, State, and ZIP

Enter your primary physician’s address, city, state, and ZIP.

Phone

Enter your primary physician’s phone number.

This section designates an alternate physician if the physician above is unwilling or unable to make a health care decision for you. This section below is optional.

Name of Physician

Enter the name of your designated physician.

Address, City, State, and ZIP

Enter your primary physician’s address, city, state, and ZIP.

Phone

Enter your primary physician’s phone number.

Part 5

Effect of Copy

This states that a copy of the California State Advance Health Care Directive has the same effect as the original.

Signature

Affix your signature.

Print Name

Enter your full legal name.

Statement of Witnesses

This section states the statement of the witnesses:

• That the individual who signed or acknowledged the Advance Health Care Directive in California is personally known to them, or the individual’s identity was proven by convincing evidence;
• That the individual signed or acknowledged this form in their presence;
• That the individual appears to be of sound mind and under no duress, fraud, or undue influence;
• That they are not a person appointed as agent; and
• That they are not the individual’s health care provider.

First Witness

Name

Enter the full legal name of the first witness.

Address

Enter the complete address of the first witness.

Signature of Witness # 1

Have the first witness affix their signature.

Date

Enter the date.

Second Witness

Name

Enter the full legal name of the second witness.

Address

Enter the complete address of the second witness.

Signature of Witness # 2

Have the second witness affix their signature.

Date

Enter the date.

Part 6

Special Witness Requirement

This section states that this part is only required if you are a patient in a skilled nursing facility that provides skilled nursing care and supportive care to patients whose primary need is for the availability of skilled nursing care on an extended basis. The patient advocate or ombudsman must sign the statement below.

Statement of Patient Advocate or Ombudsman

The patient advocate or ombudsman declares under penalty of perjury under California laws that they are a patient advocate or ombudsman as designated by the State Department of Aging and that they are serving as a witness as required under the Probate Code.

Date

Enter the date.

Name

Enter the patient advocate’s full legal name.

Signature

Have the patient advocate affix their signature.

Address

Enter the patient advocate’s complete address.

Frequently Asked Questions About the California Advance Health Care Directive

How to file the California Advance Health Care Directive?

The California Advance Health Care Directive Form must be signed in front of two witnesses or a notary public. Once you have signed the form, have it signed by the two witnesses or notarized by the notary public. Take note, however, that your witnesses must not be your health care agent. Also, do not forget to make copies of the signed form. You may give the original copy to your health care agent, and keep the other one for yourself.

You can also file the form with your local county recorder's office. This is not required, but it might be a good idea if you want to make sure that your directive is easily accessible in case of an emergency. To do this, simply take the original signed form to your local county recorder's office and ask them to file it. There is usually a small fee for this service.

To ensure that your directive is followed, it is important to talk to your health care agent about your wishes and make sure that they understand your instructions. You should also give copies of the signed form to your doctor, any other health care providers you see regularly, and anyone else who might be involved in your care. Finally, it's a good idea to review your directive every few years and update it if necessary.

Does a California Advance Healthcare Directive need to be notarized?

While there is no requirement that an Advance Healthcare Directive be notarized in California, it is generally recommended. Notarization provides an extra level of protection and can help to ensure that the Directive will be given full legal weight if it is ever needed.

If you have any questions about whether or not your Advance Healthcare Directive needs to be notarized, you should consult with an attorney or other legal professional.

Hiring an attorney is not required, but may be recommended.

How does advance directive work in California?

Advance directives are legal documents that allow you to specify your wishes for medical care if you become unable to communicate those wishes yourself. In California, there are two types of advance directives: the Durable Power of Attorney for Health Care and the Advance Health Care Directive.

The Durable Power of Attorney for Health Care appoints someone (called an "agent") to make health care decisions on your behalf if you are unable to do so yourself. The agent can be anyone you trust, such as a family member or friend. You can give your agent as much or as little authority as you want. For example, you can give your agent the authority to make all health care decisions on your behalf, or you can limit their authority to making decisions about specific treatments or procedures.

The Advance Health Care Directive is a document in which you can specify your wishes for medical care, including what types of treatments you do or do not want to receive. You can also use the Advance Health Care Directive to appoint an agent to make health care decisions on your behalf. Unlike the Durable Power of Attorney for Health Care, the Advance Health Care Directive does not need to be signed by a witness.

You can use either or both of these documents to create an advance directive. You are not required to have an advance directive, but if you do have one, it is important to make sure that your family and friends know where it is kept and how to access it.

If you have any questions about advance directives or how to create one, you should speak with an attorney.

Can a family member override an advance directive?

No, a family member cannot override an advance directive. However, if there is a disagreement among family members about what the person wanted, the person's wishes as expressed in the advance directive should be given great weight. If there is still a disagreement, the court may appoint a guardian to make decisions about the person's care.

This is why it's so important to discuss your wishes with your family members and appoint a healthcare proxy so that everyone is on the same page about your end-of-life decisions. In addition, make sure to update your advance directive regularly as your wishes may change over time.

Who makes medical decisions if there is no power of attorney in California?

If there is no power of attorney in California, medical decisions will be made by the patient's family or friends. If the patient is unable to make decisions for themselves, the doctor will make decisions based on what is best for the patient's health.

Medical professionals will often seek out the guidance of a person's family or friends when it comes to making decisions about a patient's care. However, if there is no one available to provide input, the doctor will make the decision based on what they believe is in the best interest of the patient. In some cases, this may mean making decisions based on the patient's wishes, if they are able to express them. If the patient is not able to express their wishes, the doctor will make the decision based on what they believe is in the best interests of the patient's health.

In many cases, family or friends of the patient will be available to provide input on medical decisions. However, if there is no one available, the doctor will make the decision based on what they believe is in the best interest of the patient's health. In some cases, this may mean making decisions based on the patient's wishes, if they are able to express them. If the patient is not able to express their wishes, the doctor will make the decision based on what they believe is in the best interests of the patient's health.

Does a healthcare power of attorney need to be notarized in California?

There is no requirement that a healthcare power of attorney should be notarized in California. However, if you choose to have your healthcare power of attorney notarized, it may make it easier for your agent to use the document in some situations. For example, if your agent needs to show the document to a healthcare provider in order to make medical decisions on your behalf, the healthcare provider may be more likely to accept the document if it is notarized.

What is the difference between a living will and an advance directive?

A living will is a legal document that allows you to state your wishes for medical care in the event that you are unable to communicate those wishes yourself. An advance directive is a broader term that can encompass a living will, as well as other documents such as a durable power of attorney for health care. A durable power of attorney for health care gives someone else the legal authority to make decisions about your medical care if you are unable to do so yourself.

These documents can be used to express your wishes about a wide range of topics, including life-sustaining treatment, organ donation, pain management, and end-of-life care. It is important to note that living wills and advance directives are not binding on medical providers. However, they can be an important tool in communicating your wishes to your loved ones and medical care team.

For you to create a valid living will or advance directive, you must be of legal age and of sound mind. You should also discuss your wishes with your loved ones and medical care team so that they are aware of your wishes and can help to ensure that they are carried out.

Can a family member override the power of attorney?

No, a family member cannot override the power of attorney. The authority of the person named in the power of attorney document is granted by the person who signs the document (the "principal"). As such, the authority of the person named in the power of attorney cannot be taken away by someone else, even a family member.

If you have any questions about the authority granted in a power of attorney document, or if you believe that someone is trying to override the power of attorney, you should speak with an attorney.

What happens if a patient does not have an advance directive?

If a patient does not have an advance directive, then the healthcare team will make decisions based on the best interests of the patient. The patient's family may also be involved in decision-making.

To ensure that all patients have the opportunity to express their wishes regarding end-of-life care, healthcare providers should ask about advance directives at every visit. Patients should also be provided with information about advance directives so that they can make informed decisions about their care.

Advance directives are an important part of end-of-life care, but they are not the only factor that should be considered. The healthcare team will also take into account the patient's medical condition, prognosis, and preferences.

It is important to remember that advance directives are not set in stone. They can be changed at any time by the patient. Patients should review their advance directives periodically to make sure that they still reflect their wishes.

Can doctors turn off life support without family consent in California?

There is no simple answer to this question. In general, doctors cannot unilaterally turn off life support without the consent of the patient or the patient's family. However, there may be circumstances when a doctor could override the wishes of the patient or family, such as if continuing life support would be futile or cause undue suffering.

To avoid potential conflict, it is always best to discuss a patient's end-of-life wishes with the family in advance. That way, everyone is on the same page and there is less chance of misunderstanding or disagreement down the road.

An advance health care directive is one way to document a person's end-of-life wishes. This is a legal document that can appoint someone to make health care decisions on the person's behalf if they are unable to do so themselves. It can also spell out the person's specific wishes regarding life support and other treatments. Advance directives are not required in California, but they can be helpful in ensuring that a person's wishes are respected.

What happens if you don't have an advance directive in California?

If you don't have an advance directive in California, your family members or closest friends will have to make decisions about your medical care if you become incapacitated. This can be a difficult situation for them, and it may not be what you would want. It's important to think about these things ahead of time and discuss them with your loved ones so that everyone is on the same page. If you don't have an advance directive, it's still a good idea to let your family know your wishes in case something happens to you.

Who makes medical decisions if there is no advance directive?

If there is no advance directive, then medical decisions will be made by the patient's family or friends, depending on who is available and willing to make decisions. If the patient is unable to communicate their wishes, then the decision-maker will have to rely on their best judgment to make decisions in the best interest of the patient. It is always best to have an advance directive in place so that there is no question about who should make medical decisions on behalf of the patient.

Are Five Wishes legal in California?

According to the California state website, Five Wishes is not currently recognized as a legal document. However, the site also states that this may change in the future, so it's always best to check with an attorney or other legal professional to be sure. In the meantime, there are other advance directives that are legally binding in California, such as the Advance Health Care Directive and Durable Power of Attorney for Health Care.

What are the 5 Wishes Questions?

1. What do you want most in life?
2. What are your biggest dreams?
3. What do you hope to achieve?
4. Who do you want to be remembered as?
5. What legacy do you want to leave behind?

These are just a few of the 5 Wishes questions that can help you start thinking about what you really want in life. There are no right or wrong answers, but taking the time to think about and answer these questions can help you begin to focus on what's truly important to you. So take some time for yourself and see what 5 Wishes can do for you. You may be surprised at what you discover.

What is the most common statement in a living will?

There are many different types of living wills, and the wording of each one will be slightly different. However, a common statement found in many living wills is something along the lines of, "In the event that I am no longer able to make decisions regarding my medical care, I hereby state that I do not want any life-sustaining treatments to be used." This gives the individual's loved ones and medical team clear guidance on what kinds of treatment should or shouldn't be used if the individual is unable to communicate their wishes themselves.

Here are other common phrases found in living wills:

• "I want to be kept comfortable, but I do not want my life to be prolonged artificially."
• "I do not want heroic measures used to keep me alive, but I do want palliative care to manage my pain and suffering."
• "In the event that I am no longer able to make decisions regarding my medical care, I hereby state that (insert name of designated decision maker) is authorized to make all decisions on my behalf."
• "I understand that this document expresses my wishes regarding future medical care, but that it is not binding on my health care providers or loved ones."

Make sure you understand all the content of your living will before signing it. You may also want to appoint a health care proxy, which is someone you designate to make decisions on your behalf if you are unable to do so yourself. You can name the same person as your health care proxy and your decision maker in your living will, or you can choose two different people.

What are the most common 3 types of advance directives?

The most common three types of advance directives are:

• Living Will — A living will is a written document that states your wishes regarding medical treatment if you are unable to communicate them yourself.
• Durable Power of Attorney — A durable power of attorney for healthcare gives someone else the legal authority to make medical decisions on your behalf if you are unable to do so yourself.
• Do Not Resuscitate — A DNR order is a legal order from a doctor that instructs medical staff not to attempt CPR if you stop breathing or your heart stops beating.

These are just a few of the most common advance directives. There are many others that can be used to tailor your end-of-life care to your specific wishes. Speak with your doctor or a legal professional to learn more about the different types of advance directives and how they can be used to ensure that your wishes are followed if you are unable to communicate them yourself.

What is the main disadvantage of a living will?

The main disadvantage of a living will is that it can be difficult to make decisions about your end-of-life care in advance. This is especially true if your health changes over time. Living wills also may not cover all possible medical situations. For example, they typically do not address organ donation or resuscitation. Finally, living wills are only legally binding in some states. This means that even if you have a living will, your doctor or hospital may not be required to follow it.

Who can make decisions for someone who lacks capacity in California?

In California, only a few people can make decisions for someone who lacks capacity. These people are called "conservators." A conservator is usually a family member or close friend, but it can also be a professional person. To be appointed as a conservator, the person must file a petition with the court and show that the person lacks the capacity to make decisions for him or herself. Once the conservator is appointed by the court, he or she will have the legal authority to make decisions on behalf of the person who lacks capacity.

Related Articles:

• A guide to making a California advance health care directive
• Advance directive vs. living will: What's the difference?
• Advance Care Planning: Health Care Directives