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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 California. 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.

    Enroll online for our Life Care Planning Workshop  – You’ll learn about the role of a health care decision-maker, how to complete an Advanced Health Care Directive, and more.

    Step 1 icon

        

    Download and complete California’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 English

    Download English (large print)

    Download Español (Spanish)

    Download 中文 (Chinese)

    Download Tiếng Việt (Vietnamese)

    Download 日本語 (Japanese)

    Download 한국어 (Korean)

    Download العربية (Arabic)

    Download Հայերեն (Armenian)

    Download РУССКИЙ (Russian)

    Download فارسی (Farsi)

    Download Ελληνικά (Greek)

    Download Tagalog

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

    If you wish you decline transfusions or blood products, please download and print the blood refusal form, fill it out with pen and submit it following the instructions below. 

    Download English

    Download Español (Spanish)

    Download 中文 (Chinese)

    Step 2 icon

       

    Submit your completed and signed AHCD form

    You can submit your completed and signed form in one of 3 ways:

    • By email: SCALCentralized-Scanning-Center@kp.org

    • By mail:
      Central Scanning
      1011 S East St
      Anaheim, CA 92805

    • In person: Drop off a copy at any Kaiser Permanente location or at your next scheduled appointment.
    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.