Who will speak for you if you’re ever too sick to make decisions for yourself? Through an
Advance Health Care Directive, you can designate who you want to speak on your behalf and even what kinds of treatments you want.
It’s better to express your wishes before you get very sick or have to go into a health care facility. You can do so by using an Advance Health Care Directive. It’s called an advance directive because you prepare one before health care decisions need to be made, and because it states who will speak on your behalf and what should be done.
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. Fill out the form, and give copies to your designated representative, physician and health care institution.
- Advance Directive form (PDF, 200 KB)
- Directiva por anticipado de la atención de la salud (PDF, 190 KB)
Also available is the Physician Orders for Life-Sustaining Treatment (POLST) form (PDF, 290 KB). This is a written medical order that allows people with serious illnesses to specify the types of medical treatment they want to receive. The POLST form complements an Advance Directive and is not intended to replace that document.
If you’ve already completed an Advance Directive, it is your responsibility to provide
the hospital with a copy.