English

The Advance Health Care Directive is a legally binding form that lets you exercise your right to give instructions about your own health care and/or to name someone else to make health care decisions for you in the event you are unable to speak for yourself. If you use this form, you may complete or modify all or any part of it. You are free to use a different form. In any case, agents designated and signatures required must be done in the manner prescribed on this form and mandated by the California State Legislature.

It is recommended that you use this form and complete the whole form. Completing this form will revoke any previous health care directives. It is advisable to also complete the Values Checklist we provide and include that as an attachment to your Advance Directive to help clarify your wishes.

Equally important is having meaningful conversations with people who care about you so that they know and understand your wishes concerning end of life care. Guidelines to help Talking Things Over are provided on this site to help you through the process.

Upon completion of your Advance Healthcare Directive, copies should be distributed to family members and those who would care for you in the event of a life-threatening condition. It is also recommended that you keep a current copy of your Advance Directive in the glove box of your vehicle.

PDF format

Download Advance Healthcare Directive in PDF format. (You need the free Acrobat Reader to open and print this file.)

DOC format

Download Advance Healthcare Directive in DOC format. (You must have Microsoft Word or a compatible program to open and print this file.)

en Espanol

Download Advance Healthcare Directive in Spanish

English

The End of Life Values-Choices Checklist is a form that lets you think about end of life choices and values, and commit them to writing.

If you prefer, you can download the End of Life Values-Choices Checklist in Microsoft Word (.doc) format.

Spanish

The End of Life Values-Choices Checklist is a form that lets you think about end of life choices and values, and commit them to writing.

If you prefer, you can download the End of Life Values-Choices Checklist in Microsoft Word (.doc) format.

Rooted in community, Memorial Hospice has been providing quality, compassionate hospice care and grief services to individuals and families facing life-threatening illness or the death of a loved one since 1997. Memorial Hospice and our sister program, Hospice of Petaluma, are a service of the St. Joseph Health System, a Ministry of the Sisters of St. Joseph of Orange.

Patients and families receive interdisciplinary patient care with individualized attention to nursing, psychosocial, spiritual and practical needs that may arise at the end of life. Memorial Hospice is proud of serving the Spanish-speaking community with our Latino Grief Services program and bi-lingual patient care staff. Hospice services are provided by professional staff and specially trained caregiver and grief support volunteers. Volunteer trainings are held in the spring and fall with both daytime and evening classes.

[Values Checklist — English and Spanish]

“Opciones para el Final de la Vida: Lista y Guía de Valores”- Community Network, Susan Keller

“End of Life Choices: A Values Checklist and Guide” - Community Network, Susan Keller

Excellent book for family conversations about values and quality of life. Available in Spanish and English

Obtain from: A Better Way Coalition (Idaho Residents and Programs) abetterway@cableone.net.

Free Outside of Idaho from Susan Keller, Community Network.

Seniors & the Law—A Guide for Maturing Californians is the third in a series of State Bar consumer education guides and is available in both English and Spanish.