The California Advance Health Care Directive is used when you want to appoint someone else on your behalf to make health care related decisions, the agent will be able to make the decisions when the principal is incapable of making the decisions on his own or otherwise stated. You may not choose your attending physician to be your agent. This form can only be used in the state of California.
How to Fill the California Advance Health Care Directive
This document is divided into several parts concluding multiple points and begins with appointing the agent by providing their full and legal name (first, middle, last), date of birth, complete address with the city, state & zip code. If you wish to appoint the agent to make health care decisions for you even when you are in the mental capacity to do so, then you must place your initials in the field where it says “optional”.
Then provide all the necessary details of the primary, 1st & 2nd alternative agent. These details should include their full name (first, middle, last), their addresses along with the city, state & zip code and phone number.
In the next segments, the points which state what the agent may & must do are stated which generally include: accept or decline any treatment, choose physician or facility, receive and review medical information or records, take decisions keeping in mind the wishes of the grantor and if they are unaware of the same then consult their loved ones before they do so. If you wish to exclude someone from being consulted then their name must be mentioned and in the end an initial must be placed for both the points. After the demise of the grantor all the actions that can be performed by the agent are also mentioned and if there are any exceptions then they must be stated followed by their initials.
In the second part of the form all the health care instructions are covered ranging from trust in agent, personal care decisions, DNS order & revocation of previous documents. The initials of the grantor must be stated after every point verifying the same.
The third part of the form requires the signature of the person who is making this directive.
And lastly in the fourth part of the document several points require attention, first being the document must be notarized or signed by two witnesses, carefully read and understand the declaration given in accordance with the laws of California, If the grantor is admitted in a nursing facility then a representative of California’s Long-Term Care Ombudsman Program is also required as a third witness and if the two-witness method is chosen then they may serve as one of the two witnesses, or may serve as a third witness followed by a signature under its declaration.
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California Advance Health Care Directive
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California Advance Health Care Directive