Pennsylvania Advance Health Care Directive

Jurisdiction: Pennsylvania
Purpose: Medical & health care
Source / form version: FormUPMC 4034; PATEX_BH 3/22; ©2022 UPMC; twelve pages
Resource format: PDF
Signing: Use two qualified adult witnesses and follow the publisher’s additional witness exclusions. The form uses witness signatures rather than requiring a notary.

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Sources checked: 2026-11-13. General information, not individual legal advice.

A combined medical planning packet

UPMC’s twelve-page packet helps you choose a health care decision-maker, explain your treatment preferences and complete signatures. You may appoint backups and decide how much flexibility your agent has when applying your written wishes. The document uses plain-language examples to help you describe a life and level of function that matter to you.

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Choose when your agent may help

The agent section asks whether authority should begin now or only when you cannot make your own decisions. Read that selection with the rest of the document rather than assuming every medical appointment works the same way. Treatment choices, organ donation, autopsy and funeral directions are separate options; complete the parts that express your own wishes after discussing medical questions with your care team.

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Follow the packet’s witness safeguards

The packet includes principal and witness pages that must stay with the appointment. Its witness instructions are more restrictive than the statutory minimum: they exclude the agent and specified care-provider or facility relationships and require one witness without a family or inheritance interest. Follow those printed safeguards when using this form. Give a full signed copy to your decision-maker and providers. A directive does not itself become a current resuscitation or other medical order; discuss those orders separately if needed.

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Common questions

Does the agent section always wait for incapacity?

This UPMC form lets you choose authority starting now or only when you cannot make decisions. Select the option that matches your intention and discuss it with your agent.

Sources: [2] [1]

Related forms and guides

Sources and verification

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The date above records a source check. It does not certify that a form is suitable for your circumstances or that an attorney has reviewed your document. Read the publisher’s current instructions before use.