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 State of California. 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.

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.

1. Download and complete California’s AHCD form

You have two options to complete the Advance Directive. You can choose the Short Form or the Long Form. Both options allow you to document your health care decision maker and give guidance on your treatment decisions. The long form asks additional questions about what is important to you. Whichever form you select, it will need to be notarized or witnessed to make it a legal document.

Select the form that you prefer below. You can download, save it to your computer, and type your information directly into the form. NOTE: If you do not rename the file, it will not save the details you enter. Once complete, you will need to print the form and have it signed by a notary or two witnesses.

You can also print the form and fill it out using a pen.

If you wish to 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 blood refusal declaration

Download Español (Spanish blood refusal declaration)

Download 中文 (Chinese blood refusal declaration)

2. 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.

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.

Connecting to care

Call us 24/7 and talk with a licensed care clinician about your questions or concerns. Find your local phone number below. 

Phone icon

Call 24/7 for advice

If you need help choosing the care that’s right for you, give us a call.


 

Envelope icon

Message your care team

Prefer to write? Message your care team anytime with medical questions.


 

Calendar icon

Schedule an appointment

Schedule in-person check-ups, phone or video visits, and other appointments.