California Advance Health Care Directive Form

Jurisdiction: California
Purpose: Medical & health care
Source / form version: Undated PDF; statutory form notes January 1, 2019
Resource format: PDF
Signing: Two qualified witnesses or acknowledgment; skilled-nursing-facility rule also applies

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

Understand the separate parts

Part 1 appoints an agent and optional alternates. Part 2 records treatment instructions. Parts 3 and 4 address organ donation and a primary physician. Your agent appointment and your written care instructions serve related but different purposes.

The Attorney General encourages discussing end-of-life wishes with the people involved in your care. Read the form’s explanation before completing it, and ask your clinician to explain medical choices you do not understand.

Sources: [1] [2]

Choose an agent and when authority begins

Check the restrictions on appointing providers, facility operators and employees in the form’s explanation. Discuss willingness, availability and your wishes with the proposed agent, then consider alternates.

The form ordinarily starts the agent’s authority when the primary physician determines that you cannot make your own health care decisions. It also offers a box for immediately effective authority. Limits and other wishes can be recorded in the spaces supplied.

Sources: [2]

Choose the correct signing arrangement

The ordinary execution choices are two qualified witnesses or acknowledgment before a notary. For the witness route, read every eligibility statement in Part 5. At least one witness must also sign the additional statement concerning family relationship and entitlement to the estate.

Skilled nursing facility: Part 6 requires a designated patient advocate or ombudsman as a witness when you are a patient in such a facility. Arrange this with the facility; notarization does not remove that additional protection. The final PDF page provides a notarial acknowledgment section.

Sources: [2]

Share your wishes and the signed document

Give complete copies to your agent and relevant providers, and explain where the original is stored. California’s Secretary of State offers voluntary registration of information about an already executed directive. Registration does not replace completing and signing the directive.

Sources: [1] [3]

Common questions

Is registering the directive required before I can use it?

The Secretary of State describes registration as voluntary. First prepare and execute the directive; registration records information about it and does not replace signing.

Sources: [3]

Is the directive the same as a financial power of attorney?

No. It addresses health care instructions and an agent for health care. The separate California statutory financial form is the resource for financial and property powers.

Sources: [1] [4]

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.

California Advance Health Care Directive and Medical Power of Attorney