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Advance Health Care Directive
Planning medical decisions in case of an accident or illness is something everyone should think about. If there’s an emergency, it’s important to make sure you get the kind of care you want—even if your loved one or doctor has to decide for you.
What is an Advance Health Care Directive?
The Advance Health Care Directive (AHCD) is a legal form that lets you
- Choose a health care agent—someone who can make decisions for you if you can’t. This is also called a “durable power of attorney for health care” or “medical durable power of attorney.”
- Give instructions about the care you want if you can’t make decisions yourself.
- Share your values, hopes, and what matters most to you.
The Advance Health Care Directive also helps you learn about life-sustaining treatments and decide what care you would want. Making these choices now, while you’re healthy, gives you a voice for the future.
It’s a good idea to look at your life care plan from time to time and talk with your loved ones about what’s important to you. You can update your AHCD anytime, especially if your health or life changes. Filling it out while you’re healthy and talking about it with your loved ones can help avoid confusion later and give everyone peace of mind.
How to Complete an Advance Health Care Directive
The forms and steps for making your Life Care Plan are different depending on where you live. To get started, please choose your state or region.
Your Life Care Plan can be made legally binding in Maryland, Virginia, and Washington, D.C. Each place has its own approved forms and rules, but the best option is to complete an Advance Health Care Directive (AHCD).
Make sure you share any legal forms you fill out with both your health care agent and Kaiser Permanente.
1. Complete the 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 details you enter.
CRISP is Maryland’s dedicated healthcare exchange network that facilitates the electronic transfer of clinical information between different health information systems. Learn more about CRISP’s recommendations for creating and sharing your AHCD.
Download Maryland's AHCD form (English) | Maryland's AHCD form - Español (Spanish) | Maryland's AHCD form - 한국어 (Korean) | Maryland's AHCD form - 中文 (Chinese)
Download Maryland Health Care Commission’s Advance Directive information sheet (English)
Download Virginia's AHCD form (English) | Virginia's AHCD form - Español (Spanish) | Virginia's AHCD form - 한국어 (Korean) | Virginia's AHCD form - 中文 (Chinese)
Download Washington, D.C.'s form (English) | Washington, D.C.'s form - Español (Spanish) | Washington, D.C.'s form - 한국어 (Korean) | Washington, D.C.'s form - 中文 (Chinese)
The form includes directions for how to fill it out.
2. Submit your completed and signed AHCD form to Kaiser Permanente
Please submit your completed form to be added to your health records one of the following ways (in order of preferred method):
- Upload through your KP App or on a desktop through your Kp.org MyChart account (must be PDF format as a single document- pictures or photos cannot be used)
- Login
- Click on menu
- Scroll down to ‘Records & Documents’ and select ‘Life Care Planning’
- New window will open- follow prompts to upload
- Fax the completed form to 1-855-889-3320
- Bring your completed Advance Directive to any of the following Kaiser locations with open HIMs (Medical Records) office:
| Maryland: | Virginia |
| Gaithersburg Medical Center – 655 Watkins Mill Rd, First Floor, Gaithersburg, MD, 20879 | Falls Church Medical Center – 201 N Washington St, Falls Church, VA, 22046 |
| Kensington Medical Center – 10410 Kensington Pkwy, Kensington, MD, 20895 | Springfield Medical Center – 6551 Loisdale Ct, Springfield, VA, 22150 |
| Largo Medical Center – 1221 Mercantile Ln, Upper Marlboro, MD, 20774 | Tysons Corner Medical Center – 8008 Westpark Dr, McLean, VA, 22102 |
| Silver Spring Medical Center – 11901 Bournefield Way, Silver Spring, MD, 20904 | Woodbridge Medical Center – 1400 Derby Loop, Woodbridge, VA, 22192 |
| South Baltimore Medical Center – 1701 Twin Springs Rd, Halethorpe, MD, 21227 | |
| White Marsh Medical Center – 8141 Honeygo Blvd, Nottingham, MD, 21236 | Washington D.C. |
| Lutherville-Timonium Medical Center – 2391 Greenspring Dr, Timonium, MD, 21093 | Capitol Hill Medical Center – 700 2nd St. NE, Washington D.C., 20002 |
4. Mail To:
Kaiser Permanente
New Carrollton Administration Building
4000 Garden Center Dr, 4th floor Document Imaging (DIT)
Hyattsville, MD, 20785
3. 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 chosen as your health care agents.
Tell your people
The best way to make your life care plan known is to share your wishes for future health care with the people in your life. Your life care plan can only be acted upon if people know about it. Share it with your health care agent, other loved ones, friends, roommates, and Kaiser Permanente. Share your plan verbally and in writing.
Also, keep any important documents, such as your Advance Health Care Directive, in a place that is easy for you and others to access. Give a copy to your health care agent, your family members, and your doctor.
To update your Advance Health Care Directive
You can change your life care plan at any time, as long as you are capable of understanding and communicating your health care decisions. In fact, it is not unusual to make changes over time. We encourage you to periodically review your values and wishes for your future health care to make sure that what you specified at an earlier point in time continues to reflect what you want.
If you want to make changes to your Advance Health Care Directive (AHCD), you'll need to fill out a new one. Give the new version to your doctor, your agent, and anyone else who has a copy of your old AHCD. Ask your agent and family members to bring you the old versions of your AHCD so you can discard them.
You will also need to let your doctor, agent, and loved ones know of the changes to your life care plan or AHCD. Remember, as long as you are able to speak for yourself, the choices you make while hospitalized will be honored, even if they differ from those expressed in your written AHCD.
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