The California Advanced Health Care Directive form is a legal document that allows individuals to specify their health care preferences and appoint a trusted person to make medical decisions on their behalf if they become unable to do so. This directive is essential for ensuring that one's wishes are honored in critical health situations. To take control of your health care decisions, consider filling out this important form by clicking the button below.
Filling out the California Advanced Health Care Directive form is an important step in planning for your future medical care. This document allows you to express your wishes regarding healthcare decisions in case you become unable to communicate them yourself. Here are some key takeaways to consider:
When filling out the California Advanced Health Care Directive form, it’s essential to be careful and thorough. Here are some important do's and don'ts to keep in mind:
Taking these steps seriously can help ensure your healthcare preferences are honored. Act promptly to complete your directive.
Not Designating a Healthcare Agent: Many individuals fail to appoint a healthcare agent to make decisions on their behalf. This omission can lead to confusion and potential conflicts during critical times.
Ignoring Specific Instructions: Some people leave the sections detailing their medical preferences blank. Without clear instructions, healthcare providers may not understand the individual's wishes, which can result in unwanted treatments.
Not Updating the Directive: Life circumstances change. Failing to update the directive after major life events, such as marriage, divorce, or the death of a previously designated agent, can lead to outdated decisions being followed.
Overlooking Witness Requirements: The California Advanced Health Care Directive requires signatures from witnesses. Some individuals neglect this step or do not ensure that their witnesses meet the legal requirements, which can invalidate the document.
Not Discussing the Directive: A common mistake is not discussing the directive with family members or the designated healthcare agent. Open conversations about preferences can help ensure that everyone understands the individual’s wishes and can advocate for them effectively.
The California Advanced Health Care Directive is similar to a Living Will. Both documents express an individual's wishes regarding medical treatment in the event they become unable to communicate those wishes. A Living Will specifically outlines the types of medical interventions a person does or does not want, focusing on end-of-life care. This document is often used to guide healthcare providers and family members in making decisions aligned with the individual's values and preferences.
It is essential to explore similar legal forms that ensure a person's wishes are respected regarding their healthcare decisions. For instance, understanding how Durable Power of Attorney forms function can illuminate their significance, as they allow individuals to appoint someone to make decisions on their behalf in times of need. Resources like NY PDF Forms provide comprehensive details about these critical documents and their implications for safeguarding your healthcare rights.
Another similar document is the Durable Power of Attorney for Health Care. This form allows an individual to appoint someone else to make medical decisions on their behalf if they are incapacitated. Like the Advanced Health Care Directive, it ensures that a person's healthcare preferences are honored. However, while the Advanced Health Care Directive can include specific treatment preferences, the Durable Power of Attorney focuses more on designating a trusted person to make decisions.
The Medical Power of Attorney is also comparable. This document grants authority to another individual to make healthcare decisions for someone else. It is similar to the Durable Power of Attorney for Health Care but may not always include the detailed instructions about medical treatment found in an Advanced Health Care Directive. Both documents prioritize ensuring that an individual's healthcare wishes are respected when they cannot voice them themselves.
A Do Not Resuscitate (DNR) order shares similarities with the California Advanced Health Care Directive. A DNR specifically instructs medical personnel not to perform CPR if a person's heart stops or they stop breathing. While the Advanced Health Care Directive can encompass broader healthcare preferences, a DNR focuses solely on resuscitation efforts, making it a more specific directive within the realm of medical care.
The Physician Orders for Life-Sustaining Treatment (POLST) form is another related document. POLST is designed for individuals with serious illnesses or frailty. It translates a patient’s treatment preferences into actionable medical orders. Similar to the Advanced Health Care Directive, POLST ensures that medical personnel follow the patient's wishes regarding life-sustaining treatments, but it is often used in emergency situations and is recognized by first responders.
The Five Wishes document is also comparable. This form goes beyond medical preferences to include personal, emotional, and spiritual wishes. It addresses how individuals want to be treated and what they want their loved ones to know. Like the Advanced Health Care Directive, it serves to guide healthcare providers and family members, but it provides a more holistic approach to end-of-life care.
Another similar document is the Health Care Proxy. This allows individuals to designate someone to make healthcare decisions on their behalf. While it is akin to the Durable Power of Attorney for Health Care, a Health Care Proxy typically does not include specific treatment instructions. Instead, it focuses on appointing a trusted person to ensure that healthcare decisions align with the individual's values and preferences.
The Release of Medical Records is also relevant. This document allows individuals to grant permission for healthcare providers to share their medical information with designated individuals. While it does not directly address treatment preferences like the Advanced Health Care Directive, it is essential for ensuring that appointed decision-makers have access to necessary medical information to make informed choices.
Finally, the Living Trust can be considered somewhat similar, though it primarily deals with asset management rather than healthcare decisions. A Living Trust allows individuals to specify how their assets should be managed during their lifetime and distributed after their death. While not directly related to medical care, it reflects the broader theme of making decisions about one’s future and ensuring that personal wishes are honored.
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In addition to understanding the importance of a General Power of Attorney form in New York, it is also beneficial to have access to resources that provide templates and guidance in completing such documents. For those interested, a reliable source can be found at https://nytemplates.com/, which offers a blank general power of attorney template that can assist individuals in navigating this legal process effectively.
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A California Advanced Health Care Directive is a legal document that allows individuals to outline their healthcare preferences in case they become unable to communicate their wishes. It combines two key components: a durable power of attorney for healthcare and a living will. This directive ensures that your medical decisions align with your values and desires, even when you cannot voice them yourself.
Any adult who is 18 years or older and is of sound mind can create an Advanced Health Care Directive in California. It is important to consider your personal values and preferences when drafting this document, as it will guide healthcare providers and loved ones in making decisions on your behalf.
When creating your Advanced Health Care Directive, consider including the following:
To appoint a healthcare agent, you must specify the individual in your Advanced Health Care Directive. This person should be someone you trust to make decisions in accordance with your wishes. It is advisable to discuss your preferences with your chosen agent beforehand to ensure they are comfortable with the responsibility.
Yes, California law requires that your Advanced Health Care Directive be signed by you and either witnessed by two individuals or notarized. Witnesses must be at least 18 years old and cannot be your healthcare provider or an employee of your healthcare provider. Notarization is an alternative to having witnesses sign your document.
Yes, you can change or revoke your Advanced Health Care Directive at any time, as long as you are of sound mind. To make changes, simply create a new directive or write a statement revoking the previous one. Ensure that you inform your healthcare agent and any relevant parties about the changes.
Store your Advanced Health Care Directive in a safe but accessible place. Consider giving copies to your healthcare agent, family members, and healthcare providers. It is also a good idea to keep a copy with your medical records for easy access in case of an emergency.
If you do not have an Advanced Health Care Directive and become unable to make your own healthcare decisions, California law will designate a hierarchy of individuals who may make decisions on your behalf. This typically includes your spouse, adult children, parents, and siblings. However, these individuals may not fully understand your wishes, which could lead to decisions that do not align with your preferences.
Yes, you can use a template to create your Advanced Health Care Directive. The State of California provides a free template that meets legal requirements. However, it is advisable to customize the document to reflect your specific wishes and consult with a legal professional if you have any questions or concerns.
It is recommended to review your Advanced Health Care Directive regularly, especially after major life changes such as marriage, divorce, or the birth of a child. Changes in your health status or personal beliefs may also warrant a review. Keeping your directive up-to-date ensures that it accurately reflects your current wishes.
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)