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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 states of Oregon and Washington. 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 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 information you enter.

    Download Oregon’s AHCD form English | Español 

    Download Washington’s AHCD form English | Español

    Download Oregon/Washington’s AHCD form Español (Spanish)

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

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

    Download Oregon/Washington’s AHCD form 日本語 (Japanese)

    Download Oregon/Washington’s AHCD form Français (French)

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

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

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

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    Submit your completed and signed AHCD form

    NOTE: During the COVID-19 crisis, you may submit your AHCD remotely in one of the following ways:

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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.