The California Advanced Health Care Directive form is a legal document that allows individuals to outline their preferences for medical treatment in the event that they are unable to make decisions for themselves. This critical tool ensures that a person's healthcare wishes are known and considered when they cannot express these preferences due to illness or incapacity. It empowers individuals by giving them control over their future health care decisions.
Ensuring one's health care wishes are honored in the event of incapacitation is a concern for many individuals. The California Advanced Health Care Directive form serves as a critical tool in this process, providing a structured way for people to document their preferences for medical treatment and end-of-life care. It uniquely merges two crucial components: the Living Will and the Power of Attorney for Health Care, allowing individuals to appoint a health care agent to make decisions on their behalf and to specify their wishes regarding life-sustaining treatment, organ donation, and other critical care choices. This form not only guides health care providers in making informed decisions aligned with the patient's desires but also alleviates the decision-making burden on family members during stressful times. Completing the form is a forward-thinking step, ensuring that one's health care choices are clearly communicated and legally recognized in California.
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)
The California Advanced Health Care Directive form allows individuals to outline their wishes regarding healthcare in the event that they are no longer capable of making decisions for themselves. This important document consists of two main parts: a Power of Attorney for Health Care, which designates an individual to make healthcare decisions on your behalf, and instructions for health care, where you can detail the specific medical treatments you do or do not want to receive. Filling out this form clearly and accurately ensures that your healthcare preferences are understood and respected. Here is a step-by-step guide on how to complete the form:
After the form is filled out and properly signed, keep it in a safe but accessible place. Informing your family members, close friends, and healthcare providers about the existence of this directive and where it is stored will ensure that your healthcare wishes are honored.
What is a California Advanced Health Care Directive?
An Advanced Health Care Directive in California allows individuals to outline their preferences for medical care if they become unable to make these decisions themselves. It includes appointing a health care agent to make decisions on their behalf and specifying wishes regarding end-of-life care, resuscitation, and organ donation, among other preferences.
Who should have a California Advanced Health Care Directive?
Any adult over the age of 18 may benefit from having an Advanced Health Care Directive. It's especially important for those with strong preferences about their health care, those with chronic or serious health conditions, and individuals concerned about potential incapacity due to illness or injury.
How do I choose a health care agent?
When choosing a health care agent, consider someone you trust to respect your wishes and advocate on your behalf. This person should be emotionally resilient and able to make potentially difficult decisions under stress. It's often beneficial to discuss your health care preferences with your chosen agent in advance.
Can I change my Advanced Health Care Directive?
Yes, you can change or revoke your Advanced Health Care Directive at any time as long as you are competent. To make changes, you should complete a new document and ensure that your health care provider, health care agent, and any other relevant parties receive the updated version.
What should I include in my directive?
Your directive should clearly state your personal wishes regarding various types of medical care, including life-sustaining treatment, pain management, and organ donation. Detailing your preferences for scenarios in which you're unable to communicate can guide your health care agent and medical providers.
Is a lawyer required to complete an Advanced Health Care Directive in California?
No, a lawyer is not required to complete an Advanced Health Care Directive in California. The form is designed to be understandable without legal assistance. However, consulting a lawyer can be helpful, especially if your health care wishes are complex or if you have significant estate planning considerations.
How do I make my Advanced Health Care Directive legally binding?
To make your Advanced Health Care Directive legally binding in California, complete the form, then sign and date it in front of two adult witnesses who must also sign, or have it notarized. Your witnesses cannot be your designated health care agent or related to you by blood, marriage, or adoption.
What happens if I don't have an Advanced Health Care Directive?
If you become incapacitated without an Advanced Health Care Directive, decisions about your health care will be made by medical professionals or appointed guardians according to California state law. This might not align with your personal wishes, emphasizing the importance of creating a directive.
Should I inform my family about my Advanced Health Care Directive?
Yes, it's advisable to discuss your Advanced Health Care Directive with your family and anyone involved in your care. This ensures that your wishes are understood and respected, and can help avoid confusion or conflict during stressful times.
Where should I keep my Advanced Health Care Directive?
Your Advanced Health Care Directive should be easily accessible to your designated health care agent and family members. Provide copies to your primary care physician and any other health care providers to include in your medical records. It's also wise to keep a copy in a safe but accessible place at home.
One common mistake people make when filling out the California Advanced Health Care Directive form is not providing clear instructions about their health care preferences. This form is designed to communicate a person's wishes regarding medical treatment in situations where they cannot speak for themselves. Vague or ambiguous language can lead to confusion among healthcare providers, potentially resulting in care that does not align with the person's desires.
Another error involves neglecting to appoint an alternate agent. While it's critical to choose a primary agent who will make health care decisions if the person is unable, selecting a reliable alternate is equally important. Life's unpredictability means the primary agent might not always be available, so having a backup ensures that someone is always there to advocate for the person's healthcare preferences.
Not discussing wishes with the appointed agent beforehand is also a mistake. It’s essential that the person chosen to make health care decisions understands the responsibilities involved and agrees with the preferences outlined in the directive. Without this clear understanding and agreement, the agent may feel uncertain or conflicted when the time comes to make tough decisions.
Failure to update the directive is a mistake that can lead to significant issues down the line. People's preferences for medical treatment can change over time, as can relationships with those named in the document. It's important to review and revise the directive periodically to ensure it still reflects current wishes and circumstances.
Many individuals make the error of incorrectly assuming that a lawyer must complete the form. While consulting a legal professional can provide clarity and ensure all bases are covered, it's not a requirement for the validation of the document. The directive primarily needs to be completed accurately, signed, and, in California, either notarized or witnessed by two eligible persons.
Forgetting to distribute copies of the directive to important parties is another oversight. The healthcare agent, alternate agent, close family members, and healthcare providers should all have access to the document. This ensures that the individual's health care preferences are known and can be easily referenced when necessary.
Some people mistakenly believe that completing the form is all that's required. However, discussing the contents and one's wishes with the healthcare agent and, ideally, with close family members, is equally critical. These conversations can provide additional clarity and help avoid conflicts or confusion in the future.
Failing to include specific wishes for different medical scenarios is a mistake that can render a directive less effective. It's beneficial to consider various health situations and specify preferences for each. Such specificity helps healthcare providers understand what treatments should or should not be administered in different circumstances.
Signing the document without witness or notary acknowledgement where required is a critical error. In California, for the directive to be legally binding, it must be either signed in front of a notary public or witnessed by two adults who meet certain criteria. Overlooking this step can invalidate the directive.
Lastly, a common mistake is not registering the directive with a registry or saving it in an easily accessible place. Some states offer registries where directives can be stored and retrieved as needed by healthcare providers. Even if a state does not offer this service, keeping the document in a known and accessible location, such as with personal medical records, ensures it can be found when needed.
In California, the Advanced Health Care Directive form allows individuals to outline their preferences for medical treatment should they become unable to make decisions themselves. Accompanying this essential document, there are often several other forms and documents that should be considered to ensure a comprehensive approach to future medical and personal care planning. These additional documents can provide clarity, legal authority, and peace of mind for both the individual and their loved ones.
Ensuring that all relevant forms and documents accompany the California Advanced Health Care Directive form can significantly impact the quality of care one receives and the ability to carry out their wishes with respect to health care decisions. Preparing these documents in advance and discussing them with loved ones and health care providers is key to effective health care planning. It is advisable to seek legal guidance to ensure that all documents are correctly completed and legally binding.
The Living Will is closely related to the California Advanced Health Care Directive, as both documents enable individuals to outline their preferences for medical treatment in the event they can no longer communicate their wishes directly. A Living Will typically focuses on life-sustaining treatments and end-of-life care, much like an Advanced Health Care Directive, which also allows one to designate a health care agent to make decisions on their behalf.
A Durable Power of Attorney for Health Care shares similarities with the California Advanced Health Care Directive by permitting an individual to appoint an agent to make health care decisions for them if they become incapacitated. Both documents ensure that someone the individual trusts can make medical decisions according to their preferences, but the California Advanced Health Care Directive often includes more detailed instructions about the person's health care wishes.
The Medical Power of Attorney is another document akin to the California Advanced Health Care Directive, as it grants an agent the authority to make health care decisions on behalf of the grantor. While both documents serve similar purposes, the California Advanced Health Care Directive is more comprehensive, frequently incorporating both the medical power of attorney and living will elements in a single form.
The Do Not Resuscitate (DNR) Order is a document that instructs medical personnel not to perform CPR if a patient's breathing stops or if their heart stops beating. It has similarities with the California Advanced Health Care Directive, as it also communicates a specific medical preference. However, the Advanced Health Care Directive covers a broader range of medical treatments and decisions beyond just resuscitation preferences.
A POLST (Physician Orders for Life-Sustaining Treatment) form complements the California Advanced Health Care Directive by translating the wishes specified in the directive into actionable medical orders. While the POLST is used by patients facing serious health conditions to specify preferences for life-sustaining treatments in a more immediate sense, the Advanced Health Care Directive sets broader goals and preferences for future health care decisions.
The Five Wishes Document is similar to the California Advanced Health Care Directive, with the key difference being its emphasis on the personal, emotional, and spiritual needs of the individual, alongside their medical and legal wishes. This document serves as both a guide to having a conversation about care preferences and a legal document in many states, akin to how the California Advanced Health Care Directive outlines care preferences and appoints a health care agent.
The Mental Health Advance Directive is designed specifically for individuals with psychiatric conditions to outline their preferences for treatment during a mental health crisis. This directive is similar to the California Advanced Health Care Directive, as it serves a similar purpose in allowing individuals to provide instructions for their care in advance. However, it focuses exclusively on psychiatric care rather than broader health care decisions.
The HIPAA Authorization form is a key document that allows an individual to specify who can have access to their private health information. While its primary purpose is to ensure the privacy of health data, it intersects with the California Advanced Health Care Directive to the extent that it allows the designated health care agent or representative to access the individual's medical records, enabling informed decisions about their care.
The Out-of-Hospital Do Not Resuscitate (DNR) Order, like the hospital-issued DNR, directs emergency medical personnel not to perform CPR under certain conditions. This document complements the California Advanced Health Care Directive by specifically addressing emergency situations outside the hospital. While the Advanced Health Care Directive may include broader instructions about treatments and interventions, the Out-of-Hospital DNR focuses specifically on the immediate response to cardiac arrest or respiratory failure outside a medical facility.
Filling out the California Advanced Healthcare Directive form is an important step in managing your health care preferences. As you embark on this critical process, there are key dos and don’ts to keep in mind to ensure your directive is clear, valid, and reflective of your wishes.
Do:
Don’t:
When it comes to making decisions about future healthcare, the California Advanced Health Care Directive (AHCD) form is a critical document. However, misunderstandings about its purpose and use are common. Here are nine misconceptions that people often have:
It's only for the elderly. People of all ages can face sudden medical crises. The AHCD is crucial for ensuring that your healthcare wishes are known and respected, regardless of your age.
You need a lawyer to complete it. While legal advice can be helpful, especially in complex situations, the form is designed to be completed without a lawyer. Clear instructions are provided, making it accessible to everyone.
It only covers "Do Not Resuscitate" orders. The AHCD is much broader. It allows you to make comprehensive healthcare decisions, including the types of treatments you would or wouldn't want and appoint someone to speak for you if you can't speak for yourself.
Once completed, it can't be changed. You can update or revoke your AHCD at any time as long as you are mentally capable. Changes should reflect your current wishes, ensuring your healthcare preferences are always up to date.
It's the same as a living will. While similar, the AHCD in California is more comprehensive than a simple living will. It includes appointing a healthcare agent, providing more detailed instructions about your healthcare preferences.
Your family can override it. The AHCD is legally binding. Healthcare providers must follow it, even if family members disagree with your choices. This ensures your wishes are honored, not overruled.
It guarantees your wishes will be followed in every situation. While the AHCD is influential, unforeseeable circumstances and emergency interventions might lead to temporary deviations. However, it serves as a strong guide for your healthcare team.
All healthcare providers have immediate access to it. Unless you've shared your AHCD with your healthcare providers or have it readily available, they might not know about it. It's crucial to inform key people about your directive and where it's stored.
It's too complicated to fill out. The form might seem daunting, but it's structured to be user-friendly. Taking it step by step can help you express your healthcare wishes clearly and decisively.
Recognizing these misconceptions about the California Advanced Health Care Directive form can empower you to take control of your healthcare decisions confidently. Carefully considering and filling out this document ensures that your wishes are known, helping to guide your loved ones and healthcare providers in the event you cannot communicate your healthcare preferences yourself.
The California Advanced Health Care Directive form is a crucial document for individuals who wish to outline their preferences for medical care, should they become unable to make these decisions themselves. The form empowers you to appoint a health care agent, specify your health care wishes, and make other important medical decisions in advance. Here are key takeaways about filling out and using this form:
Completing the California Advanced Health Care Directive is a proactive step towards ensuring your health care preferences are respected. It provides peace of mind for you and your loved ones, knowing that decisions made will be aligned with your values and wishes.
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