Advanced directive
Through an Advance Health Care Directive, you can designate someone to speak on your behalf and even determine treatments you want or do not want. In California, the part of an Advance Directive you can use to appoint an agent to make health care decisions is called a Power of Attorney for Health care. The part where you can express what you want done is called an Individual Health care Instruction. As long as you are over 18 years old and capable of making your own medical decisions, you can complete an Advance Directive, and you do not need a lawyer.
Use the form below to choose someone to speak for you, if needed, and to indicate your wishes regarding medical treatment. Give copies to your designated representative, physician and to the hospital during pre-registration.
Click here to download (in pdf format) the Advance Health care Directive form:
Advanced Directive Instructions | Advanced Directive Instructions – Spanish
Advance Directive Form – English | Advance Directive Form – Spanish
If you’ve already completed an Advance Directive, it is your responsibility to provide the hospital with a copy.