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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.

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    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. If you do not rename the file, it will not save the information 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 complete it using a pen.

    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)

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    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.
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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.