Planning

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

This important study and related reports released by the California Healthcare Foundation in March 16, 2007 reports that: In California, the most populous and diverse state in the country, significant racial and ethnic differences exist at the end of life. These reports – the first in a new series of CHCF-supported projects focusing on end-of-life issues - found significant variations in the expectations, experiences, and decisions of patients and their families in the months preceding death.

“As California’s diverse population grows older, ensuring quality care at the end of life for everyone takes on even greater significance,” Mark D. Smith, M.D., M.B.A., president and CEO of CHCF, said Thursday at the Association of Health Care Journalists conference in Los Angeles. “By supporting research and projects to improve the quality of end-of-life care, CHCF sees an opportunity to help make California a national example of best medical practices and culturally appropriate care.”

[Five Wishes — Advance Directive Workbook]

2000 Envejecimiento con Dignidad Spanish language version of the popular guide to completing advance directives. Funded by Robert Wood Johnson Foundation.

Obtain from: Aging with Dignity. $1 if ordering 25 or more.

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.

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.

[Health Care Decisions]
Projecto de Hospicio del Valle (Hospice of the Valley) Educational booklet about health care decisions and advance directives. Presented in an easy to understand question and answer format.
1501 E. Flower, Phoenix, AZ 85014 (602) 222-2229

Obtain from: www.hcdecisions.org This may be a free resource.

Kaiser Permanente Santa Rosa Medical Center provides this site to inform seniors and their caregivers about classes and resources of value. Programs are generally open to the community-at-large and include support groups for diabetes and classes concerning mental health, advance care planning, wellness through life’s end, managing ongoing conditions and many others. A link to the Kaiser Santa Rosa education catalogue is also provided along with links to area hospices and senior resources.