Advance Directives

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

Caring Connections, a program of the National Hospice and Palliative Care Organization (NHPCO), is a national consumer engagement initiative to improve care at the end of life, supported by a grant from The Robert Wood Johnson Foundation.

Caring Connections
-Provides free resources, information and motivation for actively learning about end-of-life resources.
-Promotes awareness of and engagement in efforts to increase access to quality end-of-life care.
-Helps people connect with the resources they need, when they need them.
-Brings together community, state and national partners working to improve end-of-life care.

The Center for Practical Bioethics offers a variety of publications, video and audiotapes designed to enhance ethics education and promote discussion of ethics issues. Links are provided for free material and for items to purchase via their online store.

Case studies provide a way for us to analyze and think-through difficult medical and moral situations. This Center for Practical Bioethics webpage links you to stories that will challenge you to think clearly as you consider options at the crossroads of decision.

In thousands of ways, social workers help people help themselves. People of every age. From every background. In every corner of the country - wherever we’re needed - starting here and now. Welcome to your source for professional advice, inspiring stories - even a social worker directory. Social workers. Help starts here. This website is provided by the National Association of Social Workers and includes sections on Seniors and Aging, Issues and Answers, Mind and Spirit. The Senior section includes in-depth look issues of import, real life stories shared, resources of value, current trends, helpful tip, options and other information helpful for finding one’s way through the senior years. The Health and Well Being section includes information related to death and dying, living with illness, pain management, etc. The Mind and Spirit section includes orientation to various mental illnesses, grief & loss and other helpful information.

Dr. Menkin maintains some useful downloadable documents on her website at Kaiser. When we checked, these were available:

• Santa Teresa’s Advance Directive Form
• Generic Advance Directive and Instructions for Generic AD form
• Sample Attachment for an Advance Directive
• PreHospital DNR form and CPR FAQ’s
• Tube Feeding FAQ’s
• Respecting Choices Brochure Sept 04
• Respecting Choices Brochure November 04
• AD Class flier

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, Hospice of Petaluma 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 1977. Hospice of Petaluma and our sister program, Memorial Hospice, 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. 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.

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.