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Advance Health Care Directive

Ready to complete the form?

    The documents and processes for making your Life Care Plan vary by state. To begin, please select your state or region from the drop-down menu at the top of the page. 

    Your Life Care Plan can be made legally binding in the State of Georgia. Although there are a number of documents and processes legally approved by your state to complete this task, ideally we would like you to complete an AHCD (Advance Health Care Directive). 

    Please make sure that any legal document you complete is shared with both your health care agent and Kaiser Permanente.

    If you would like help with completing your AHCD, please call 1-770-431-4162.

     

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    Download and complete Georgia’s AHCD form

    You can download and print this form to fill out with a pen or save it to your computer and type into it. To save the form from a browser window, choose File, then Save As, and then rename the file. 

    NOTE: If you don’t rename the file, it WILL NOT save the information you enter.

    Download English

    Download Español (Spanish)

    Follow the instructions in the form to complete it for submission.

    By Georgia state law, your AHCD must be signed by TWO witnesses other than your selected health care agent in order to be valid. 

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    Submit your completed and signed AHCD form

    You can submit your completed and signed form by fax, email, mail or in person:

    • Fax: 1-866-480-8085
    • Mail:
      Kaiser Permanente HIMS
      3200 Breckenridge Blvd.
      1st floor, East Wing
      Duluth, GA 30096
    • In person: Drop off a copy at any Kaiser Permanente location or at your next scheduled appointment.
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    Keep your original, and share copies

    Always store your original AHCD form in a safe place with your other important papers. 

    Make sure you share copies of any legal document related to your AHCD with the people you've designated as your health care agents.

    If you would like help with completing your AHCD, please call 1-770-431-4162.