The Advance Health Care Directive is a document I frequently notarize for people about to have a surgical procedure or arrive at the emergency room due to an accident or sudden illness. Most people never think they’ll need an Advance Health Care Directive until the day it becomes necessary. Why wait until the day the nurse walks into your hospital room with all the important documents to sign and you realize you can’t complete an Advance Health Care Directive without 2 qualified witnesses or a Notary Public? Why not complete this form now and give it to your Agent for safe keeping? Let’s start at the beginning. What is an Advance Health Care Directive Form? Click on the link below and the 5 page California Advance Health Care Directive Form will come up on a PDF-fillable form. You can type in the information directly on your computer and print out the document. Read the form carefully and take time to express your wishes. Do not sign or date the document until you’re in front of a Notary Public or 2 qualified witnesses.
Qualified Witnesses cannot be any of the following:
Cannot be a person appointed as agent by this advance directive, not the individual’s health care provider, not an employee of the individual’s health care provider, not an operator of a community care facility, not an employee of an operator of a community care facility, not an operator of a residential care facility for the elderly, and not an employee of an operator of a residential care facility for the elderly.
At least one of the witnesses must also sign the following declaration:
“I further declare under penalty of perjury under the laws of California that I am not related to the individual executing this advance health care directive by blood, marriage, or adoption, and to the best of my knowledge, I am not entitled to any part of the individual’s estate upon his or her death under a will now existing or by operation of law.”
Finding witnesses that meet the required qualifications once you’re a patient in a hospital is next to impossible. The staff cannot act as witnesses on any documents needing to be notarized. Asking a family member visiting another patient can be extremely uncomfortable. The easiest way to get this document signed and avoid the challenge of finding witnesses at any time of day or night is call A Mobile Notary Public (if you’re in San Diego). http://www.amobilenotarypublic.com Check online or in the phone book for a mobile notary if you need this document notarized at a medical facility outside of San Diego, California.
California Probate Code Section 4701:
You have the right to give instructions about your own health care. You also have the right to name someone else to make health care decisions for you. This form lets you do either or both of these things. It also lets you express your wishes regarding donation of organs and designation of your primary physician. If you use this form, you may complete or modify all or any part of it. You are free to use a different form.
Part 1 of this form is a power of attorney for health care. Part 1 lets you name another individual as agent to make health care decisions for you if you become incapable of making your own decisions or if you want someone else to make those decisions for you now even though you are still capable. You may also name an alternate agent to act for you if your first choice is not willing, able, or reasonably available to make decisions for you. (Your agent may not be an operator or employee of a community care facility or a residential care facility where you are receiving care, or your supervising health care provider or employee of the health care institution where you are receiving care, unless your agent is related to you or is a coworker.)
Unless the form you sign limits the authority of your agent, your agent may make all health care decisions for you. This form has a place for you to limit the authority of your agent. You need not limit the authority of your agent if you wish to rely on your agent for all health care decisions that may have to be made. If you choose not to limit the authority of your agent, your agent will have the right to:
(a) Consent or refuse consent to any care, treatment, service, or procedure to maintain, diagnose, or otherwise affect a physical or mental condition.
(b) Select or discharge health care providers and institutions.
(c) Approve or disapprove diagnostic tests, surgical procedures, and programs of medication.
(d) Direct the provision, withholding, or withdrawal of artificial nutrition and hydration and all other forms of health care, including cardiopulmonary resuscitation.
(e) Make anatomical gifts, authorize an autopsy and direct disposition of remains.
Part 2 of this form lets you give specific instructions about any aspect of your health care, whether or not you appoint an agent. Choices are provided for you to express your wishes regarding the provision, withholding, or withdrawal of treatment to keep you alive, as well as the provision of pain relief. Space is also provided for you to add the choices you have made or for you to write out any additional wishes. If you are satisfied to allow your agent to determine what is best for you in making end-of-life decisions, you need not fill out Part 2 of this form.
Part 3 of this form lets you express an intention to donate your bodily organs and tissues following your death.
Part 4 of this form lets you designate a physician to have primary responsibility for your health care. After completing this form, sign and date the form at the end. The form must be signed by two qualified witnesses or acknowledged before a notary public. Give a copy of the signed and completed form to your physician, to any other health care providers you may have, to any health care institution at which you are receiving care, and to any health care agents you have named. You should talk to the person you have named as agent to make sure that he or she understands your wishes and is willing to take the responsibility.
You have the right to revoke this advance health care directive or replace this form at any time.
Fill out this Advance Health Care Directive Form now and get it witnessed or notarized. Why wait until the day you really need this form? Do it now. You’ll thank me later.