Advance Health Care Directive - California

California · Fillable PDF · Free

Includes a Health Care Power of Attorney to name your health care agent, plus instructions for your medical care. This California statutory packet includes instructions and wallet cards. You want to name someone to make health care decisions if you cannot.

Health Care Power of Attorney in California

The California Advance Health Care Directive includes a Power of Attorney for Health Care, also called a medical power of attorney or health care POA. This part lets you name an agent to make health care decisions for you as specified in the form. The directive also lets you record your treatment preferences. It does not give your agent authority over your finances; a financial power of attorney is a separate document.

Download Advance Health Care Directive - California PDF · 11 pages. No account required.

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Who this form is for

Adults reviewing who may make health care decisions for them.
People documenting care preferences to discuss with a physician or attorney.
Families preparing for a home, hospital or care-facility signing.

What you'll need

Your chosen agent's contact details and any alternates.
Your care preferences and physician details, if you choose to include them.
Acceptable photo ID and the witness or notary arrangements specified in the packet.

How to complete it

Read the cover and statutory explanation; the form does not cover financial matters.
Complete the sections you choose, with legal or medical questions directed to an attorney or physician.
Arrange signing according to the packet. A skilled nursing facility patient also needs the required patient advocate or ombudsman witness, even with notarization.
Follow the distribution instructions and review the included wallet cards.

Related California forms

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General (Financial) Power of Attorney - California

Name an agent to handle financial and property matters using California's statutory form. This form addresses finances, not health care decisions.

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HIPAA Authorization - California

Identify who may release your health information and who may receive it. This is separate from appointing someone to make health care decisions.

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Medical Consent for a Minor - California

Authorize another adult caring for your child to consent to medical or dental care within the stated scope.

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Revocation of Advance Health Care Directive - California

Identify an earlier health care directive or agent appointment you want to revoke. The packet includes instructions and a distribution record for notifying others.

View Revocation of Advance Health Care Directive - California · Download Revocation of Advance Health Care Directive - California

These forms are a free convenience, not legal advice. First Choice Mobile Notary & Apostille is not a law firm. Consult an attorney licensed in the relevant state for legal questions.

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