The California Advanced Health Care Directive form is a legal document that allows individuals to outline their preferences for medical care in the event that they become unable to make decisions themselves. This essential form ensures that a person's medical treatment aligns with their values and wishes, even when they can't communicate. For those looking to have a say in their medical care planning, click the button below to fill out the California Advanced Health Care Directive form.
The California Advanced Health Care Directive form serves as a critical tool for individuals to communicate their wishes regarding medical treatment in situations where they are unable to speak for themselves. This form combines the powers of a living will and a durable power of attorney for health care into a single, comprehensive document. It allows people to specify the types of medical treatment they desire or wish to avoid at the end of their lives, appoint a health care agent to make decisions on their behalf, and provide instructions for organ donation, if desired. Through this form, individuals can ensure their health care preferences are known and respected, even when they cannot actively participate in the decision-making process. The availability and acceptance of the form across California make it a fundamental component of health care planning, offering peace of mind to both the individuals who complete it and their families. It stands as a testament to the importance of proactive health care management and personal autonomy.
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)
In order to properly fill out a California Advanced Health Care Directive form, it is essential to understand the sequential steps involved. This document allows individuals to outline their preferences for medical treatment in the event they are unable to make decisions for themselves due to incapacity. By taking the time to complete this form thoughtfully, individuals can ensure their healthcare wishes are known and can designate an agent to make decisions on their behalf if necessary. The process involves several key steps, from personal identification to signing before witnesses or a notary public.
After completing these steps, it's important to communicate with the individuals involved. Discuss your wishes and any responsibilities with your chosen health care agent and alternate agent, if applicable. Provide copies of the completed form to your health care agent, primary physician, and any other relevant healthcare providers. Keeping a copy in an accessible location at home and informing a close friend or family member of its location are also good practices. This ensures that your advanced health care directive can be easily found when needed, guiding your healthcare while respecting your wishes.
What is a California Advanced Health Care Directive?
An Advanced Health Care Directive in California is a legal document that allows individuals to outline their preferences for medical treatment and appoint someone to make health care decisions on their behalf if they become unable to do so. It serves as a guide for doctors and caregivers, ensuring that the individual's wishes regarding their health care are respected, even when they cannot communicate those wishes themselves.
How does one choose a health care agent for their Advanced Health Care Directive?
Choosing a health care agent is a significant decision. This person should be someone trustworthy, who understands the individual's values and wishes, and is willing to advocate on their behalf. Typically, people select a close family member or a friend. It's essential to have a conversation with the chosen agent about the responsibilities involved and to make sure they are willing and able to act in this role before appointing them in the directive.
Can an Advanced Health Care Directive be changed or revoked?
Yes, an individual has the right to change or revoke their Advanced Health Care Directive at any time, as long as they are still mentally competent. To make changes, one can either complete a new directive or add an amendment to their existing document, stating the specific changes. To revoke the directive, it's enough to inform the health care provider or the appointed agent verbally or in writing.
Is an attorney required to complete an Advanced Health Care Directive in California?
While it's not required to have an attorney to complete an Advanced Health Care Directive, consulting with one can be beneficial. An attorney can help clarify the legal aspects of the document, ensure that it accurately expresses the individual's wishes, and may provide advice on how to effectively communicate those wishes. However, many people complete the form without legal assistance by following the provided instructions.
What happens if someone does not have an Advanced Health Care Directive?
If an individual becomes incapacitated without an Advanced Health Care Directive in place, health care decisions will typically be made by their closest available relative, as stipulated by California law. This might not always align with the individual's wishes, which is why having a directive is crucial. It provides a clear guide to healthcare professionals and family members about the person's healthcare preferences, including treatments they do or do not want.
Does the Advanced Health Care Directive need to be notarized or witnessed in California?
The California Advanced Health Care Directive does not need to be notarized, but it must be signed in the presence of two adult witnesses or acknowledged before a notary public. The witnesses must also sign the document, attesting that the individual is known to them, voluntarily signed the document, and appears to be of sound mind and under no duress, fraud, or undue influence. Certain restrictions apply to who can serve as a witness to ensure impartiality.
Not specifying preferences clearly is a common mistake. Individuals often fill out the form without detailed consideration of specific medical interventions like mechanical ventilation, feeding tubes, or resuscitation. This lack of clarity can leave healthcare providers and loved ones unsure of the patient's true wishes in critical situations.
Failing to update the directive to reflect current wishes and health status. As people age or their health changes, their preferences for care might also change. However, many forget to update their directive, leading to a disconnect between the care they receive and the care they would have chosen for themselves.
Choosing an agent without adequate consideration. The person selected to make healthcare decisions on behalf of the individual should be trustworthy, willing, and able to act according to the individual's wishes. Making a choice based on obligation or expectation, rather than thoughtful consideration, can result in the designation of an agent ill-equipped for the role.
Not discussing wishes with the chosen healthcare agent and family members. By not having this crucial conversation, individuals risk having their healthcare agent and loved ones make decisions that do not align with their own preferences, particularly in high-pressure situations where quick decisions are necessary.
Omitting a secondary agent. If the primary healthcare agent is unable to fulfill their role when needed, not having a secondary (or alternate) agent can complicate decisions about care. This omission can lead to delays in treatment and the possibility of decision-making falling to someone not chosen by the individual.
Not signing in the presence of the required witnesses or a notary public. The form may be legally invalid if it's not executed according to California law, which requires witnessing by two individuals or notarization, depending on the circumstances. This oversight can render the directive unenforceable when it is needed most.
Assuming the form is only for the elderly or terminally ill. Many individuals delay completing an Advanced Health Care Directive under the mistaken belief that it is only necessary for those at the end of life. However, unexpected medical situations can occur at any age, making it crucial for everyone to have a directive in place.
When planning for future health care decisions, the California Advanced Health Care Directive form plays a crucial role in ensuring one’s wishes are respected and followed. However, to comprehensively cover all aspects of a person’s health and estate planning, this form is often accompanied by several other documents. Each of these documents serves a specific purpose, complements the directive, and helps to create a well-rounded approach to planning. Below are some of the key documents often used in conjunction with the California Advanced Health Care Directive.
Together with the California Advanced Health Care Directive, these documents form a foundation for articulating one’s wishes and ensuring they are followed, covering a range of decisions from medical care to financial matters. It's important for individuals to discuss their wishes with their loved ones and legal counsel to ensure that all documents are correctly filled out and legally binding. Additionally, it is advisable to review and update these documents regularly to reflect any changes in one’s health, financial situation, or personal wishes.
Living Will: This document, like the California Advanced Health Care Directive, allows individuals to specify their wishes regarding medical treatment if they become unable to make decisions for themselves due to illness or incapacity. Both documents guide healthcare providers on whether to offer or withhold life-sustaining treatments.
Durable Power of Attorney for Health Care: Similar to one aspect of the California Advanced Health Care Directive, this document designates another person (agent) to make health care decisions on behalf of the individual (principal) if they are not capable. Both forms ensure someone can make health decisions aligned with the individual's preferences.
POLST (Physician Orders for Life-Sustaining Treatment): While the California Advanced Health Care Directive covers a wide array of future health care preferences, a POLST is a doctor's order that outlines specific medical treatments a patient wants to receive towards the end of life. Both documents communicate the patient's wishes to healthcare professionals.
Do Not Resuscitate (DNR) Order: A DNR is a medical order to not perform CPR if a patient's breathing stops or if the patient’s heart stops beating. The California Advanced Health Care Directive can include instructions that reflect a DNR's intent, specifying if and when resuscitation should be attempted.
Medical Power of Attorney: This grants a designated agent the authority to make all types of health care decisions on behalf of the grantor, not just those concerning life-sustaining treatment. This is similar to the aspect of the California Advanced Health Care Directive that appoints a health care agent, although the directive may also have instructions limiting the agent's power in certain respects.
Five Wishes Document: This document goes beyond medical issues to address personal, emotional, and spiritual needs as well as medical wishes. It serves a similar purpose to the California Advanced Health Care Directive by outlining how a person wants to be treated if they become seriously ill.
Mental Health Advance Directive: Specifically focused on decisions related to mental health treatment, this document outlines the individual's preferences regarding psychiatric medication, hospitalization, and other mental health interventions. Like the California Advanced Health Care Directive, it is utilized when the individual is unable to make informed decisions themselves.
When it comes to filling out the California Advanced Health Care Directive form, it's vital to approach the task with care and understanding. This document not only reflects your medical care preferences but also designates a person to make health care decisions on your behalf if you're unable to do so. Below are key dos and don'ts to consider.
Do:
Don’t:
When it comes to planning for future health care, many people turn to the California Advanced Health Care Directive (AHCD) form. This powerful document allows individuals to outline their health care preferences and appoint someone to make medical decisions on their behalf if they are unable to do so themselves. However, there are several common misconceptions about the AHCD form that need to be clarified.
One of the most prevalent misconceptions is that the AHCD is only necessary for the elderly or those facing terminal illness. In reality, life is unpredictable, and unforeseen medical emergencies can happen to anyone, regardless of age or current health status. The AHCD form is a valuable tool for all adults, providing peace of mind that their health care wishes will be respected, no matter what the future holds.
Many people mistakenly believe that completing an AHCD form is a complex legal process that requires the assistance of an attorney. While legal advice can be helpful, especially in complicated situations, the California AHCD form is designed to be straightforward and user-friendly. Clear instructions accompany the form, guiding individuals through the process of documenting their health care preferences and selecting a health care agent.
Another common misunderstanding is that once an AHCD form is completed, it is set in stone and cannot be altered. This is not the case. Individuals have the right to revise or revoke their AHCD at any time as long as they are mentally capable. Changes in personal preferences, relationships, or medical outlook can all necessitate an update to one's AHCD, ensuring that the document always reflects current wishes.
Some people worry that by appointing a health care agent, they are giving up control over their medical decisions prematurely. It's important to understand that the health care agent only has authority to act if the person who appointed them is unable to make their own medical decisions due to incapacity. Until that point, the individual retains full control over all medical choices.
While the AHCD is a crucial tool for outlining one's health care preferences and end-of-life care, it does not cover all aspects related to a person's passing. For instance, funeral arrangements and the handling of one's estate are not covered by the AHCD and require separate documentation. Therefore, it's essential to complement the AHCD with other estate planning documents to ensure all wishes are honored.
Understanding the facts about the California Advanced Health Care Directive form empowers individuals to take control of their medical futures confidently. Dispelling these misconceptions ensures that more people can benefit from the protection and peace of mind that this crucial document offers.
The California Advanced Health Care Directive (AHCD) form is a crucial document that allows individuals to outline their wishes regarding medical treatment in the event they are unable to make decisions for themselves. Understanding the key aspects of filling out and using this form can empower individuals and their families to ensure that their healthcare preferences are respected. Here are seven important takeaways:
By understanding these key points, individuals can take proactive steps to ensure their healthcare preferences are known and respected, providing peace of mind for themselves and their loved ones.
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