Download Advance Directive Forms

When most people think about advance care planning, they think about completing an advance directive, also known as an advance healthcare directive. The law does not define which advance directive form you should use, just that the form includes some specific elements and instructions. The standard advance directive form in California allows a person to do either or both:

• Appoint power of attorney for health care (health care agent).
• Give written instructions to your health care agent and health care providers.
• Take note: Naming a power of attorney for health care is different from naming a financial or fiduciary power of attorney (someone who manages your finances). The two require different processes and forms.

A variety of advance directive formats are available. The following advance directive form meets California’s requirements:

• UCLA advance directive in English (PDF)
• UCLA advance directive in Spanish (PDF)

Completing Your Advance Directive

To complete an advance directive, follow these steps:

• Consider your goals for medical care and about who you would want to help make medical decisions if you cannot (your Health Care Agent).
• Fill this into the advance directive.
• Talk about your advance directive with your chosen Health Care Agent to ensure they understand your wishes.
• Get the advance directive notarized or have it witnessed by two people (one witness cannot be related to you).

For UCLA Patients:

• Upload: Scan the advance directive as a single file and upload it on the MyChart Advance Directive page.
• Fax: Send the advance directive to your doctor’s office via fax.
• In-Person: Bring the advance directive to your next doctor appointment to discuss it with your doctor.

Other advance directive forms are specific to selected circumstances such as:

• Jehovah’s Witnesses
• Persons with early dementia
• Persons with amyotrophic lateral sclerosis (ALS)
• Many of these can be found on Coalition for Compassionate Care of California.
• Note that not all advance directives are recognized by all states. Please check your state requirements before completing your advance directive.

PREPARE Advance Directive (California)

For those who prefer a simpler form, an easy-to-read California advance directive called Prepare for Your Care is available in multiple languages with step-by-step instructions.

• English (PDF)
• Spanish (PDF)
• Additional U.S. States and languages

California Hospital Association

• Advance Health Care Directive
  Download sample form in English and Spanish