Free California Advance Healthcare Directive

Table of Contents

1. Download a California Advance Directive Sample
2. What is a California Advance Healthcare Directive?
3. Who Should have an Advance Directive?
4. How to Select Your Agent(s)
5. Decision Making Power of Your Agent(s)
6. What to do if You Change Your Mind
7. How to Complete Your Medical Power of Attorney California

1. Download a California Advance Directive Sample

Your Free California Advance Directive Download

2. What is a California Advance Healthcare Directive?

An advance directive California, sanctioned by California Probate Code Sections 4700 to 4701, is a combination of two legal documents, a Medical Power of Attorney (MPoA) and a Living Will. A medical power of attorney allows you to appoint a person to make healthcare decisions on your behalf–if and when you become unable to make such decisions yourself. A Living Will empowers you to define your end-of-life and medical care preferences.

An advance directive California consolidates these important instructions, enabling you to protect yourself and your loved ones from any uncertainty regarding difficult healthcare decision.  For instance, you’ll answer important questions regarding:

• Who to appoint as your healthcare agent
• What authority your healthcare agent will have
• End-of-life decisions
• Post-death healthcare choices
• Donation of anatomical gifts such as organs, tissues, and other body parts

Important Definitions

Here are a few key terms that are important for you to understand, before creating your advance directive California form, as set forth by Section 4600-4643 of the California Health Care Decisions:

• Advance Healthcare Directive: Also known as an “advance directive” means either an individual healthcare instruction or a power of attorney for healthcare.

• Agent: An adult (18+ years of age) designated in a power of attorney for healthcare to make healthcare decisions for the principal.

• Alternate Agent: If your first agent is not willing, able, or reasonably available to make decisions, your alternate agent will be offered decision making power.

• Capacity: A person’s ability to understand the nature and consequences of a decisions and to make and communicate a decision.

• Skilled Nursing Facility: A health facility that provides skilled nursing and supportive care to patients whose primary need is for skilled nursing care on an extended basis, as defined by Section 1250 of the California Health and Safety Code.

• Healthcare Provider: Is an individual licensed, certified, or otherwise authorized or permitted by the law of the state of California to provide healthcare in the ordinary course of business or practice of a profession.

• Principal: An adult (18+ years of age) who executes a California medical power of attorney.

Alternative Document Names

For your reference, in California people often refer to an advance health care directive by other names:

• Advance Directive
• Medical Power of Attorney
• Living Will

3. Who Should Have an Advance Directive?

It’s a common misconception that you only need an advance healthcare directive if you are elderly, incapacitated, have an illness, or engage in a high-risk profession.

In reality, everyone 18+ years of age residing in California should have a valid California Advance Healthcare Directive. Life is uncertain, and we all run the risk of becoming unpredictably ill, seriously injured, or otherwise unable to make our own healthcare decisions. If an unfortunate scenario does arise, having an advance directive will ensure that your healthcare preferences are followed and someone you trust is making the uncertain decisions.

4. How to Select Your Agent(s)

Under the rule of, Cal PROB § 4684, your agent is required to make decisions in accordance with your healthcare instructions as well as their knowledge of your wishes. These wishes include any religious and moral beliefs as well as personal value that you may hold. If unaware of your wishes, the agent shall make decisions based on your best interests.

So, take your time with this important decision. Make sure that you select someone that you’re confident knows your personal values and has your best interests in mind.

Who to Select as an Agent:

Your agent should be a friend, family member, or professional 18+ years of age who is:

• Knowledgeable of your religious and moral beliefs as well as personal values
• Someone you trust to make healthcare decision on your behalf
• Willing to accept the responsibility of acting as your agent
• A responsible individual who can inform healthcare professionals of the decisions on your AHCD form

Who Can’t be Your Agent:

According to Cal PROB § 4659, you’re unable to select any of the following individuals to act as your agent:

• An operator or employee of a community care facility or a residential care facility where you are receiving care
• Your supervising healthcare provider
• An employee of the healthcare institution where you are receiving care, unless your agent is related to you or is a coworker

Can You Have More Than One Agent?

Yes. Although not required, you’re able to name up to two additional agents, known as an “alternate agent” and a “second alternate agent” on your California Advance Healthcare Directive form. Your alternate agent and secondary alternate agent will assume decision making responsibility if your first choice is not willing, able, or reasonably available to make decisions on your behalf.

5. Decision Making Power of Your Agent(s)

What Healthcare Decisions Are Your Agent(s) Able to Make on Your Behalf?

If no limitations are specified, your agent will be authorized to make a broad range of healthcare decisions for you, including but not limit to, the following (as stated in Cali PROB § 4617):

• Selection and discharge of healthcare provider(s) and institution(s)–unless you designate a primary physician (or alternate primary physician) on your advance directive California form
• Approve or disapprove diagnostic tests, surgical procedures, and programs of medication
• Direct the provision, withholding, or withdrawal of artificial nutrition and hydration and all other forms of healthcare including cardiopulmonary resuscitation

In addition to medical decisions, your agent will be authorized to make extraneous decisions, including post-death healthcare choices, on your behalf (as declared in Cal PROB § 4683). For example:

• Authorization of an autopsy
• Donation of anatomical gifts such as organs, tissues, and other body parts
• Direct disposition of remains
• Release of medical records relevant to decision making duties of an agent

What Healthcare Decisions is Your Agent(s) Unable to Make on Your Behalf?

If you’d like to place limitations on your agent’s authority, you can include special instructions in the specified areas on your advance directive California form.

In addition, your agent is strictly prohibited from consenting to any of the following on your behalf, in accordance with Cal PROB § 4652:

• Commitment to a mental health treatment facility
• Convulsive treatment
• Psychosurgery
• Sterilization
• Abortion

When is your agent able to begin making decisions on your behalf?

Unless otherwise stated, an agent’s decision-making authority goes into effect only after a physician declares the principal incompetent. The declaration must be made in writing and filed in the principal’s medical records.

Alternatively, the principal can declare the agent’s authority effective immediately (once the document is complete and authenticated) by selecting the appropriate box on their advance directive.

6. What to do if You Change Your Mind

How Long is Your Medical Power of Attorney California Effective?

Unless the power of attorney for healthcare provides a time of termination, the authority of your agent is indefinite, beginning at the execution of the document.

How to Revoke

A competent patient is able to revoke all or part of their advance directive California, excluding the designation of an agent, at any time in any manner that communicates their intent to revoke.

Additional circumstances in which your advance directive may become void include:

• Divorce or annulment of marriage, if your spouse is acting as the agent
• Signing a new advance directive with different limitations, specifications, or agents

The only way for a competent patient to revoke the designation of an agent is to:

• Submit a signed written document
• Personally inform the supervising healthcare provider

Once a healthcare provider, agent, conservator, or surrogate is informed of revocation, they’re required to promptly communicate the information to the supervising healthcare provider and any healthcare institutions where the patient is receiving care.

7. How to Complete Your Medical Power of Attorney California

Do You Need Witness / Notary Public Signatures?

In order for your California Advance Healthcare Directive to be legally sufficient, it needs to adhere to one of the following:

1. Be acknowledged before a notary public
2. Be signed by at least two witnesses

If your advance directive California is signed by witnesses, the following requirements must be satisfied according to California Probate Code Sections 4670 to 4678.

Special Witness Requirements

As stated in Cal PROB § 4675, If you’re a patient in a skilled nursing facility, you’re required to have a patient advocate or ombudsman serve as a special witness. This is an additional requirement to the witness specifications stated above.

What to do with Your Signed Document

Once your medical power of attorney California is signed and completed, distribute a copy of the document to following parties:

• The person you named as an agent
• Any healthcare institutions at which you’re receiving care
• Any healthcare agents you have named
• Your primary physician and any other healthcare providers you may have