California Advance Health Care Directive Guide

California combines your healthcare power of attorney and living will into a single document called the Advance Health Care Directive (AHCD). This is different from states that require two separate forms. One document covers everything: who makes decisions for you, what treatments you want or do not want, organ donation preferences, and your choice of primary physician.

This guide explains how the AHCD works, how to create one, and the California-specific rules you need to know.

What This Document Does

The California AHCD is authorized under Probate Code Sections 4700-4701. Section 4701 provides a statutory form you can use, though you are not required to use that exact form.

The AHCD has four parts:

Part 1: Power of Attorney for Health Care

This section names your healthcare agent. Your agent makes medical decisions for you when you cannot make them yourself. You can name one primary agent and one or more alternates.

Your agent can:

Consent to or refuse any medical treatment
Choose or dismiss healthcare providers
Approve or deny diagnostic tests, surgical procedures, and medications
Make decisions about organ and tissue donation
Access your medical records

Your agent cannot:

Consent to psychosurgery
Consent to sterilization
Consent to involuntary commitment to a mental health facility
Consent to convulsive treatment (as defined in Welfare and Institutions Code Section 5325)
Consent to abortion

Part 2: Individual Health Care Instructions

This is the living will portion. You write down your specific wishes about end-of-life care, life-sustaining treatments, pain management, and any other medical preferences. These instructions guide your agent and your doctors.

Part 3: Donation of Organs (Optional)

You can state whether you want to donate organs, tissues, or your entire body after death. You can limit your donation to specific organs or purposes (transplantation, research, education).

Part 4: Primary Physician Designation

You can name your preferred primary physician. This tells your agent and healthcare facilities who should be coordinating your care.

Who Can Create One

To create an AHCD in California, you must:

Be an adult (18 or older)
Have the capacity to make healthcare decisions
Act voluntarily

You do not need to be a California resident. If you receive medical care in California, a California AHCD is a good idea.

How to Create One

Step 1: Get the form. California Probate Code Section 4701 provides a statutory form. You can use it as-is, modify it, or create your own document. The statutory form is widely recognized and accepted across the state.

Step 2: Choose your agent. Pick someone who knows your values and can make difficult decisions under pressure. Your agent should be willing to follow your wishes, even if they personally disagree.

Step 3: Write your healthcare instructions. Be specific. State which treatments you want or do not want in different scenarios. Address life support, mechanical ventilation, tube feeding, dialysis, and CPR. The more detail you provide, the less guesswork your agent faces.

Step 4: Address organ donation. Decide whether you want to donate and, if so, what limits you want to set. This section is optional.

Step 5: Name your primary physician. This is also optional but helps your agent coordinate your care.

Step 6: Sign the document. You must sign your AHCD. Then you need one of the following:

Notarization, OR
Signatures of 2 witnesses

If you choose witnesses, special rules apply depending on your situation (see the Skilled Nursing Facility rule below).

Signing Requirements

Requirement	Details
Principal's signature	Required
Option A: Notarization	Sufficient on its own
Option B: Witnesses	2 required
Attorney	Not required

Who Cannot Be a Witness

Your witnesses cannot be:

Your healthcare agent
Your healthcare provider or an employee of your healthcare provider
The operator or employee of a residential care facility where you live

At least one witness must be someone who is not related to you by blood, marriage, or adoption, and who is not entitled to any part of your estate.

Skilled Nursing Facility Rule

If you sign your AHCD while you are a patient in a skilled nursing facility (SNF), a patient advocate or ombudsman must sign as a witness. This requirement applies regardless of whether you use witnesses or notarization. Even if you have your AHCD notarized, a patient advocate or ombudsman must still sign as a witness if you are in a skilled nursing facility. This rule exists to protect nursing home patients from undue influence.

When It Takes Effect

Your AHCD's power of attorney section activates when your primary physician determines that you lack the capacity to make your own healthcare decisions. Until that determination, you keep full control over your medical care.

Your healthcare instructions (the living will portion) apply whenever their triggering conditions are met. If you wrote instructions about terminal illness, they apply when your doctor confirms you have a terminal condition. If you wrote instructions about permanent unconsciousness, they apply when that diagnosis is confirmed.

Your organ donation preferences take effect at death.

HIPAA and California Medical Information Act

Federal HIPAA law allows your healthcare agent to access your medical records once your AHCD is active. California has an additional layer of privacy protection through the California Medical Information Act (CMIA, Civil Code Section 56.11). The CMIA can require separate written authorization for some disclosures of medical information.

To cover all bases, consider including a HIPAA authorization within your AHCD or as a separate document. This ensures your agent can access your records without delays or disputes, both under federal and California state law.

POLST: A Related but Separate Document

You may hear about POLST (Physician Orders for Life-Sustaining Treatment) in California. A POLST is different from an AHCD. It is a medical order signed by your doctor that tells emergency responders and hospital staff what treatments to provide or withhold. A POLST is typically used by people with serious illnesses or advanced age.

Your AHCD expresses your wishes. A POLST turns those wishes into actionable medical orders. They work together but serve different purposes. You should have an AHCD regardless of your health. A POLST is something to discuss with your doctor if you have a serious medical condition.

Special Rules to Know

Community property and agent selection. California is a community property state. Your spouse does not automatically become your healthcare agent. You must name them in your AHCD if that is what you want.

Mental health treatment. Your agent cannot consent to your involuntary commitment to a mental health facility. Separate legal procedures govern mental health holds in California (Welfare and Institutions Code Section 5150).

Agent compensation. Your agent is not entitled to compensation unless your AHCD specifically allows it.

Out-of-state recognition. California generally honors healthcare directives from other states if they were valid where executed (Prob. Code 4676). The reverse is not guaranteed. If you split time between California and another state, consider having documents for each state.

No expiration. Your AHCD does not expire. It stays in effect until you revoke it.

How to Update or Revoke

You can revoke your AHCD at any time if you have capacity. California law (Prob. Code 4695-4698) gives you several options:

Sign a new AHCD. A new directive automatically revokes the old one to the extent they conflict.
Write a revocation. A signed, dated written statement revoking your AHCD is effective.
Verbal revocation. You can tell your attending physician you want to revoke it. The physician must note the revocation in your medical record.
Destroy the document. Physically destroying your AHCD revokes it.

If you divorce or your marriage is annulled, your former spouse is automatically disqualified as your agent (Prob. Code 4697). Section 4697 explicitly references marriage dissolution and annulment; domestic partnership termination is treated similarly under California's general domestic partnership parity laws. This happens by operation of law. You do not need to create a new AHCD for this specific change, but you should create one anyway to name a new agent.

Common Mistakes

Not using the statutory form. While you do not have to use the Probate Code 4701 form, using it avoids arguments about validity. Healthcare providers recognize it immediately. Custom documents can cause delays when time matters most.

Skipping the SNF witness rule. If you sign your AHCD in a skilled nursing facility, a patient advocate or ombudsman must sign as a witness, even if you also have the document notarized. Missing this step can invalidate the entire document.

Being too vague. Instructions like "no heroic measures" leave too much room for interpretation. Specify which treatments you want and which you do not. Name the conditions under which your instructions apply.

Not addressing CMIA separately. California's medical privacy law is stricter than federal HIPAA. Including a separate CMIA authorization alongside your AHCD prevents delays in accessing your records.

Naming an agent who lives far away. Your agent may need to be present at the hospital. If your primary agent lives across the country, name a local alternate who can respond quickly.

Forgetting to distribute copies. Give copies to your agent, your alternate agent, your primary physician, and close family members. Keep the original in a safe but accessible place (not a safe deposit box that no one can open in an emergency).

How This Fits Into Your Estate Plan

Your AHCD is a core part of your California estate plan. Most Californians also need:

A last will and testament for asset distribution
A durable power of attorney for financial matters
A revocable living trust to avoid probate

The AHCD handles medical decisions. The financial power of attorney handles money and property decisions. Together with your will or trust, these documents protect you during incapacity and your family after death.

The Bottom Line

California's Advance Health Care Directive gives you a single, powerful document to control your medical care. It names your decision-maker, spells out your treatment preferences, addresses organ donation, and designates your doctor. You need either notarization or two witnesses to make it valid. If you are in a skilled nursing facility, pay extra attention to the witness rules.

Create your AHCD now. Talk to your agent about what matters to you. Give copies to the right people. And review it every few years or after major life changes like marriage, divorce, or a new diagnosis.