The California Advanced Health Care Directive form is a legal document that allows individuals to outline their preferences for medical treatment in case they are unable to make decisions for themselves due to illness or incapacity. This essential tool ensures one's healthcare wishes are known and respected when they can't speak for themselves. Understanding and completing this form empowers individuals and relieves their loved ones from the burden of making difficult healthcare decisions during stressful times.
Understanding the importance of making healthcare decisions in advance is crucial, and California provides a legal framework to help residents outline their wishes through the Advanced Health Care Directive form. This document allows individuals to specify their preferences for medical treatment if they become unable to make decisions for themselves due to illness or incapacity. It covers aspects ranging from the selection of a health care agent, who will make decisions on their behalf, to the particulars of medical treatments they wish to receive or avoid. By filling out this form, people can ensure that their healthcare preferences are known and respected, alleviate the decision-making burden from family members, and potentially avoid unnecessary medical interventions. The California Advanced Health Care Directive form is a powerful tool in planning for future health care needs, combining both a living will and a power of attorney for health care into one comprehensive document. It empowers individuals to have a say in their health care journey, even when they might not be able to express their wishes verbally.
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)
When preparing for the future, completing an Advanced Health Care Directive can ensure your healthcare preferences are respected and followed, even when you cannot communicate them yourself. This legal document allows you to outline your desires for medical treatment and appoint someone to make decisions on your behalf if you're unable to do so. The following steps will guide you through filling out the California Advanced Health Care Directive form to ensure your healthcare wishes are clearly documented and legally recognized.
By meticulously following these steps, you can complete the California Advanced Health Care Directive form effectively. This proactive approach ensures your healthcare wishes are known and can be honored, providing peace of mind to you and your loved ones.
What is a California Advanced Health Care Directive form?
An Advanced Health Care Directive form in California allows individuals to document their preferences for medical treatment and appoint a health care agent. This agent makes decisions on their behalf if they become unable to do so themselves. It also covers choices about end-of-life care and the refusal or acceptance of life-sustaining treatments.
How do I choose a health care agent?
Choosing a health care agent requires careful consideration. This person should be someone you trust, who understands your values and wishes, and is willing to advocate on your behalf. It can be a family member, a friend, or anyone you feel will respect your health care choices. Ensure the person you choose is willing to take on this responsibility and that they are aware of what it entails.
Do I need a lawyer to complete an Advanced Health Care Directive in California?
No, you do not need a lawyer to complete an Advanced Health Care Directive in California. However, it can be beneficial to seek legal advice to understand all implications fully. The form must be filled out according to your wishes, signed, and either notarized or witnessed by two adults who are not your health care agent or beneficiaries.
Can I change my Advanced Health Care Directive after it's been signed?
Yes, you can change or revoke your Advanced Health Care Directive at any time. To do so, you should inform your health care provider, your health care agent, and any other relevant parties of the changes. You will then need to complete a new form reflecting your updated wishes and go through the formal signing process again.
What happens if I don’t have an Advanced Health Care Directive in California?
If you do not have an Advanced Health Care Directive in California, decisions about your health care will be made by your closest available relative or domestic partner according to state law. Without a directive, there can be confusion or disputes among family members and medical providers about your care preferences. Creating a directive ensures your wishes are known and followed, even if you can't communicate them yourself.
One common mistake made when filling out the California Advanced Health Care Directive form is not fully completing all sections. This document requires detailed information to ensure that one's healthcare preferences are clear. Incomplete forms may lead to confusion or misinterpretation regarding the individual's desires.
Another mistake is failing to discuss wishes with the appointed health care agent. It is vital that the person chosen to make decisions on one's behalf understands their preferences, values, and desires regarding end-of-life care. Without these discussions, the agent may make decisions that are inconsistent with the individual's wishes.
Not updating the document regularly can also pose problems. As individuals age or their circumstances change, their healthcare preferences might evolve as well. Regularly reviewing and updating the directive ensures that it always reflects the person's current wishes and situation.
Overlooking the need for witnesses or a notary public is yet another mistake. California law requires that the form be either signed by two qualified witnesses or notarized to be legally valid. Neglecting this step can render the document unenforceable.
Choosing an inappropriate person as a health care agent can have significant consequences. The designated agent should be someone who is trustworthy, willing to advocate for the individual's wishes, and ideally, geographically accessible in case of emergencies. Failure to select an appropriate agent can complicate the execution of the directive.
A frequent oversight is not making the document accessible. After completing the directive, it is essential to inform family members and healthcare providers of its existence and location. A directive that cannot be found or accessed in a timely manner may be as ineffective as not having one at all.
In addition to these common mistakes, consider the following tips to ensure the effectiveness of an Advanced Health Care Directive:
When preparing for the future, it's crucial to consider all aspects of health care and end-of-life planning. The California Advanced Health Care Directive form is a fundamental document that allows individuals to outline their preferences for medical treatment and appoint an agent to make decisions on their behalf if they are unable to do so. However, this form is often just one part of a broader legal and personal readiness strategy. Several other important documents are commonly used in conjunction with the California Advanced Health Care Directive to ensure a comprehensive approach to health care planning.
Together, these documents form a network of preparations that address not only direct health care wishes but also broader aspects of personal and financial well-being. Having a comprehensive set of documents in place can provide peace of mind for both the individual and their loved ones, ensuring that all aspects of care and estate management are handled according to their wishes. It's advisable to consult with legal professionals to understand better how each of these documents fits into an individual's specific situation.
The Living Will is a document that resembles the California Advanced Health Care Directive in its primary function, which is to guide medical care decisions when an individual is unable to communicate their preferences. Both documents allow individuals to spell out their wishes regarding the types of medical treatment they would like to receive, or avoid, at the end of their life or in situations where they are not capable of making decisions for themselves. The difference largely lies in their recognition and specific provisions under state laws, with the Advanced Health Care Directive often encompassing broader powers, such as appointing a health care agent.
Power of Attorney for Health Care is another legal instrument sharing similarities with the California Advanced Health Care Directive, especially since some states integrate both concepts into a single form. Like the Advanced Health Care Directive, a Power of Attorney for Health Care enables an individual to designate a trusted person to make health care decisions on their behalf in the event they become incapacitated. The distinction generally revolves around the scope and specifics of the decisions the designated agent is authorized to make, which can vary widely between different forms and jurisdictions.
The Durable Power of Attorney (DPOA) for finances often parallels the directive in structure and intent but diverges sharply in content. Where the Advanced Health Care Directive focuses on health-related decisions, the DPOA addresses financial management and property matters. Both documents are activated under similar circumstances—namely, when an individual is deemed incapacitated—but they appoint agents to manage distinctly different aspects of a person's life and affairs.
Do Not Resuscitate (DNR) orders share a clear objective with the Advanced Health Care Directive: specifying wishes regarding life-saving treatments. Both documents inform healthcare providers about interventions an individual does or does not want. However, a DNR is much more specific, commonly directing medical personnel not to perform cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest. DNRs are typically more immediate in application, often used by individuals with serious illnesses or those in hospice care.
The POLST (Physician Orders for Life-Sustaining Treatment) or MOLST (Medical Orders for Life-Sustaining Treatment) forms closely mirror the Advanced Health Care Directive's goal to guide medical care at the end of life but are distinguished by their medical order status. These forms are completed and signed by a healthcare provider based on a patient’s wishes, providing specific instructions about certain medical treatments, such as intubation or use of antibiotics, and are mainly intended for seriously ill or frail patients for whom death within a year would not be surprising.
The Five Wishes document offers a comprehensive approach to end-of-life planning, similar to the California Advanced Health Care Directive, but places greater emphasis on personal, emotional, and spiritual needs alongside medical and legal preferences. It addresses who an individual wants to make decisions on their behalf, the kind of medical treatment they want or don't want, how comfortable they wish to be, how they want to be treated, and what they want their loved ones to know. This inclusivity goes beyond the scope of many standard health care directives.
A Will or Testament, while focusing on posthumous matters such as the distribution of assets and guardianship of minors, shares the proactive planning spirit of the California Advanced Health Care Directive. Both documents serve to lay out an individual's wishes ahead of time, thereby relieving family members of the burden of guesswork and potential conflicts during emotionally charged periods. The significant difference lies in the fact that Wills take effect only after death, while the Advance Directive is concerned with incapacity before death.
A Guardianship Nomination, found within many estate planning documents, is akin to the California Advanced Health Care Directive in that it allows for the appointment of someone to make decisions on behalf of the nominator. While the Advanced Health Care Directive typically covers decisions about medical treatment when the individual cannot do so themselves, a Guardianship Nomination can encompass a broader range of decision-making powers, including day-to-day care, for when an individual is incapacitated or for minor children.
The HIPAA Release Form, central to patient privacy rights and medical information sharing, parallels the California Advanced Health Care Directive's aspect of designating someone to make health decisions. Specifically, it allows individuals to specify who can receive their health information. This designation is crucial for the health care agent or proxy designated in an Advanced Health Care Directive to make informed decisions, highlighting the interdependence between managing health care decisions and having access to necessary medical information.
Finally, the Organ Donor Designation, often made through a driver’s license or a separate registration form, intersects with the Advanced Health Care Directive in its conveyance of specific health-related wishes. While the primary purpose is to indicate an individual's intent to donate organs upon death, it exemplifies another form of pre-emptive medical decision-making. When included within or aligned with an Advanced Health Care Directive, it ensures that an individual’s wishes about organ donation are clearly understood and respected in connection with their broader medical and end-of-life preferences.
Filling out the California Advanced Health Care Directive form is a significant step in planning for future health care decisions. It's a document that allows you to name someone to make health care decisions for you if you're unable to make them yourself and to state your wishes regarding the types of medical treatment you do or do not want. Here are some dos and don'ts to consider when completing your form:
When considering the California Advanced Health Care Directive form, several misconceptions can hinder people's understanding and its proper utilization. Clearing up these misunderstandings is crucial to ensuring that one's health care preferences are accurately recorded and respected.
You must have a lawyer to complete the form. This is not true. Individuals can fill out this form without legal assistance. The document is designed to be straightforward so that anyone can clearly state their health care wishes.
The form is only for the elderly or terminally ill. This misconception could not be further from the truth. Everyone, regardless of age or health status, should have an Advanced Health Care Directive in place. Unexpected medical situations can arise at any time, making it essential for all adults to have their preferences documented.
Once completed, the form cannot be changed. Life circumstances and preferences can evolve, and so can your Advanced Health Care Directive. This form can be updated or revoked at any time as long as the individual is competent to make these decisions.
It only covers end-of-life decisions. While the form does include provisions for end-of-life care, it also covers a broad range of health care decisions. This can include the types of medical treatments you want—or do not want—in various situations, not just those concerning terminal illness.
Filling out the form means you’ll receive less aggressive treatment. This is a common fear but unfounded. The form simply instructs doctors and caregivers about your treatment preferences, whether that means opting for all available treatments or only certain kinds. Your instructions guide your care, not the quantity of it.
The form will take effect immediately after it is signed. The directives you outline in your form come into play only under the circumstances you specify, such as if you're unable to make decisions for yourself. Until then, you remain in control of your medical decisions.
Understanding the realities behind these misconceptions can empower individuals to make informed decisions about their health care planning. The California Advanced Health Care Directive form is a valuable tool that ensures your health care preferences are known and respected, no matter what the future holds.
The California Advanced Health Care Directive form is a critical tool for ensuring that an individual's health care preferences are respected and adhered to, even when they can no longer communicate their wishes directly. This document allows individuals to outline their desires regarding medical treatment and appoint an agent to make health care decisions on their behalf. Understanding the essential aspects of this form can empower individuals to make informed decisions about their health care planning.
Utilizing the California Advanced Health Care Directive form effectively requires careful consideration and planning. By adhering to these key takeaways, individuals can take proactive steps to ensure their health care wishes are known and respected, thereby providing peace of mind for themselves and their families.
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