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 region.

Your Life Care Plan can be made legally binding in the states of Oregon and Washington. There are other legally approved ways, but ideally we would like you to complete an AHCD.

Please make sure that any legal document you complete is shared 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.

Download Oregon’s AHCD form English (Oregon AHCD) | Español (Oregon AHCD) 

Download Oregon's AHCD form Tiếng Việt (Vietnamese Oregon AHCD)

Download Oregon's AHCD form РУССКИЙ (Russian Oregon AHCD)

Download Oregon's AHCD form 中文 (Chinese Oregon AHCD)

Download Washington’s AHCD form English (Washington AHCD) | Español (Washington AHCD)

Download Washington’s AHCD form Tiếng Việt (Vietnamese Washington AHCD)

Download Washington’s AHCD form РУССКИЙ (Russian Washington AHCD)

Download Washington’s AHCD form 中文 (Chinese Washington AHCD)

The form includes directions for how to fill it out.

If you have questions about filling out your AHCD or need help, contact a health coach at 1-866-301-3866 (TTY 711) and choose option 1.

2. Submit your completed and signed AHCD for

You can submit your completed and signed form in the following ways:

To submit your form in person

Drop off a printed copy of your form at your local Kaiser Permanente Medical Office.

To submit your form electronically

Upload a PDF of the form through your account on kp.org. Go to “Medical Records” and click on “Life Care Planning.”

Or email directly to: nw-med-rec@kp.org

To submit your form by fax

Fax to: 1-866-248-9695

To submit your form by mail

Mail to:

Kaiser Permanente - Medical Records
500 NE Multnomah St.
Portland OR 97232

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.