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Contents of an Advance Health Care Directive

Designation of agent for health care: Perhaps the most important component of your AHCD is to identify and name another individual as agent to make health care decisions for you if you become incapable of making your own decisions or if you want someone else to make those decisions for you now even though you are still capable. You may also name an alternate agent to act for you if your first choice is not willing, able, or reasonably available to make decisions for you. (Your agent may not be an operator or employee of a community care facility or a residential care facility where you are receiving care, or your supervising health care provider or employee of the health care institution where you are receiving care, unless your agent is related to you or is a coworker.)


Define the scope of your agent’s authority: Your AHCD should be tailor fit to limit the authority of your agent, or to allow your agent to make all health care decisions for you. You need not limit the authority of your agent if you wish to rely on your agent for all health care decisions that may have to be made. If you choose not to limit the authority of your agent, your agent will have the right to:

• Consent or refuse consent to any care, treatment, service, or procedure to maintain, diagnose, or otherwise affect a physical or

   mental condition.

• Select or discharge health care providers and institutions.

• Approve or disapprove diagnostic tests, surgical procedures, and programs of medication.

• Direct the provision, withholding, or withdrawal of artificial nutrition and hydration and all other forms of health care, including

   cardiopulmonary resuscitation.

• Make anatomical gifts, authorize an autopsy, and direct disposition of remains.


You can give specific instructions about any aspect of your health care, including making choices regarding the provision, withholding, or withdrawal of treatment to keep you alive, as well as the provision of pain relief.


You can express an intention to donate your bodily organs and tissues following your death, or not to donate your bodily organs and tissues following your death.


You can designate a physician to have primary responsibility for your health care.

Define when your health care agent’s authority becomes effective: Unless otherwise provided in a power of attorney for health care, the authority of an agent becomes effective only on a determination that the principal lacks capacity, and ceases to be effective on a determination that the principal has recovered capacity.


Obtaining Information to assist health care agent: Although the law in California makes it clear the designated health care agent may consult with and obtain information from former health care agents, the principal’s spouse, physician or other health care providers, family members, or others, the statutory AHCD form in California is silent regarding waiver of privacy rights to medical records afforded to all persons promulgated pursuant to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), 42 U.S.C. Section 1320d and 45 CFR Parts 160, 164, or any successor legislation, and the California Confidentiality of Medical Information Act (“CMIA”), Civil Code Sections 56 to 56.37, or any successor legislation. As such, your AHCD, prepared by me, will include appropriate waivers sufficient to allow your agent access to all your medical records as required to fulfill their duty.


Legal Sufficiency of AHCD: Your AHCD must be signed and dated, and must be signed by two witnesses or acknowledged before a notary public. Give a copy of the signed and completed form to your physician, to any other health care providers you may have, to any health care institution at which you are receiving care, and to any health care agents you have named. You should talk to the person you have named as agent to make sure that he or she understands your wishes and is willing to take the responsibility.

You have the right to revoke your AHCD or replace it at any time.

Advance Health Care Directive (AHCD)

You have the right to give instructions about your own health care. You also have the right to name someone else to make health care decisions for you. An ADVANCE HEALTH CARE DIRECTIVE (“AHCD”) lets you do either or both of these things. It also lets you express your wishes regarding donation of organs and the designation of your primary physician.

With 30 years of experience, The Law Office of Daniel J. Perwich is here to help you make the right choice!