Advance Health Care Directive

It's often difficult to think about the care and treatment you may want in the event you are incapable of making your own healthcare decisions. You may unexpectedly be in a position where you cannot speak for yourself — such as an accident or severe illness — and be unable to make or communicate your treatment decisions. If this happens, you want to be assured that the decisions made match your values and wishes. You can define in advance what medical treatment you prefer.

An Advance Health Care Directive (AHCD) form lets you say what you want and who you want to speak for you. An AHCD allows you to appoint an agent who has power of attorney for healthcare to make care and treatment decisions on your behalf, and give instructions about your healthcare wishes.

As you prepare your advance directive, you'll need to follow these four important steps:

1. Get the Advanced Health Care Directive and/or Power of Attorney for Healthcare forms for your state. In general, doctors will respect your wishes even if you have a form from a different state. The California form can be downloaded, below.
2. Choose your healthcare agent(s). This should be a person or persons you trust to make decisions for you.
3. Fill out the forms and have your signature witnessed, as your state requires.
4. Give copies to your family, your doctor and your healthcare agent. Keep an extra copy for yourself in case you need to go to a healthcare facility for a procedure or illness.

PAMF's Health Education Resource Centers can help you with an AHCD. To make an appointment for a free consultation, please call:

• Danville/Dublin Center: (925) 875-6150
• Fremont Center: (510) 623-2231
• Los Gatos Center: (408) 730-2810
• Mountain View Center: (650) 934-7380
• Palo Alto Center: (650) 614-3200
• San Carlos Center: (650) 596-4261
• Sunnyvale Center: (408) 730-2810

Once you have completed the form and had your signature notarized or witnessed, take a photocopy to your primary care physician, so that it can be placed in your medical record. Give a copy to your agent(s). Keep the original for your personal records.

Helpful Resources

• Advance Care Planning
• Advance Directive: What to Include
• Bioethics Consultation
• Planning My Way

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