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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 region. 

    Your Life Care Plan can be made legally binding in the State of Hawaii. 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.

    Step 1 icon

        

    Complete Hawaii’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 AHCD form in English

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

    Step 2 icon

       

    Submit your completed and signed AHCD form

    Mail your completed and signed form to: 

    Kaiser Permanente
    c/o MRA Department
    711 Kapiolani Blvd.
    Honolulu, HI 96813

    Step 3 icon

      

    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 want more information or to request a forms packet, please contact Member Services at 1-800-966-5955 (TTY 711).