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Advance Health Care Directive

Ready to complete your 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 legal in Maryland, Virginia, and Washington, D.C. There are a number of documents or processes you can use which are legally approved by your state or district. Ideally, we would like you to complete an Advance Health Care Directive (AHCD). 

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

           

    Step 1 icon

        

    Complete the Advance Health Care Directive form

    After you open the AHCD PDF form by selecting a link below,
    you have two options for completing it:

    • Print the form and then fill it out using a black or blue pen.
    • Use Save As to rename and save the form to your computer. (The form isn’t ready for you to use until you do this.) Open the form from your computer and type directly into your copy and print it afterward. 

    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 | Español (Spanish) | 한국어 (Korean) | 中文 (Chinese)

    Download Maryland Health Care Commission’s Advance Directive information sheet (English)

    Download Virginia's AHCD form English | Español (Spanish) | 한국어 (Korean) | 中文 (Chinese)

    Download Washington, D.C.'s form English | Español (Spanish) | 한국어 (Korean) | 中文 (Chinese)

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

    Step 2 icon

       

    Submit your completed Advance Health Care Directive

    You can submit your completed AHCD form either in person or online.

    To submit the form in person
    Drop off a printed copy of your form at your local Kaiser Permanente Medical Records Department.

    Please follow these steps so your Advance Directive, Living Will, or Medical Power of Attorney form can be added to your Kaiser Permanente Medical Record:

    1. A PDF document type is preferred. Pictures or photos of your form(s) cannot be used. 
    2. Send your pages as one single document, not as separate pages. Please include all pages of the form in your single document. 
    3. Only upload an Advance Directive, Living Will, or Medical Power of Attorney form on this Life Care Planning page. 
    4. The Advance Directive, Living Will, or Medical Power of Attorney form must be signed by you and two witnesses.  The witnesses may not be the health care agent.
    5. Sign in to your kp.org account and submit your scanned form file on the life care planning page under Medical Record . (On that page, start by selecting Add a document.)
    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.

             

    Reviewed by: John W Prochnow, December 2018