California Health Care Directive

California Health Care Directive

Use a California Advance Health Care Directive to express your health care wishes and appoint a person to make medical decisions for you if, someday, you cannot speak for yourself.

This form aligns with California's statutory advance health care directive Cal. Prob. Code §4701. It is intended for use by people who expect to receive medical care in California.

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Make your health care wishes known!

It’s vitally important that those close to you understand the kind of medical treatment you would—or would not—want if you were unable to speak for yourself. You can use this California Advance Health Care Directive to describe your health care wishes and name a trusted person to oversee them. The person you name can also make other necessary health care decisions for you if you are too ill or injured to direct your own care. In addition to the advance directive, this form provides a document for revoking your health care directive and a letter for your agent, which describes the agent’s duties.

As you make this form, you will be asked about:

Your Agent

  • Who should be your health care agent?
  • Who should be your alternate agent and second alternate agent?
  • When should your agent’s authority to speak for you begin -- when you sign the document or when you become unable to make your own health care decisions?

Your Agent's Authority

Do you want to limit the scope of your agent's authority? Specifically, should your agent not have the authority to direct:

  • the withdrawal or withholding of life-prolonging procedures
  • the withdrawal or withholding of artifically administered food and water
  • the donation of your organs, parts, or tissues
  • the plans for your burial or cremation, or
  • anything else?

Your Health Care Wishes

What kind of care do you want to receive if you cannot speak for yourself? Specifically,

  • In certain dire situations, do you want your life to be prolonged?
  • Do you want to limit the medicines you receive to relieve pain?
  • Do you want to state anything else about the location of your care, palliative care, your personal or religious values, or anything else?

This form is intended for use by people who expect to receive medical care in California. It aligns with California’s statutory advance health care directive – the form in Cal. Prob. Code §4701. It complies with California law and will be familiar to health care practitioners in California. Do not use this form unless you expect to receive health care in California.

For more about this form, read the California Health Care Directive FAQ

For more about health care directives (including living wills, powers of attorney for health care, DNRs, and POLST forms), see Living Wills & Medical Powers of Attorney on

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