Free California Advance Directive Template

California calls this document an advance health care directive, and Probate Code Section 4701 prints a statutory version of it. That form pairs a power of attorney for health care with your written treatment instructions, your organ donation wishes, and your choice of primary physician.

People searching for a California advance directive almost always mean this form. However, Section 4700 makes it optional. You may complete it, modify any part of it, or use something different entirely.

The signing rules are where a California advance directive gets specific, and they change depending on where you are and how you sign.

Witnesses or a Notary, Not Both

Probate Code Section 4673 treats a written directive as legally sufficient when it carries the date, your signature, and then either an acknowledgment before a notary public or the signatures of two qualified witnesses. One route is enough.

Who Cannot Witness

Section 4674 disqualifies:

• Your health care provider, or an employee of your health care provider
• The operator or an employee of a community care facility
• The operator or an employee of a residential care facility for the elderly
• The agent you appoint in the directive

Witnesses must be adults, and each signs a declaration under penalty of perjury covering your identity, your presence, and your soundness of mind.

One Witness Has to Be an Outsider

At least one of the two has to be an outsider: no blood, marriage, or adoption tie to you, and no claim on any part of your estate. That witness signs a second, separate declaration saying so.

Signing in a Skilled Nursing Facility

Section 4675 adds a step if you are a patient in a skilled nursing facility when you sign. A patient advocate or ombudsman designated by the State Department of Aging must serve as one of your witnesses.

Electronic Directives Need a Notary

An electronic advance health care directive follows a stricter rule. The electronic version needs an acknowledgment before a notary public, so the two-witness route does not apply.

Yes. The California Secretary of State maintains an Advance Health Care Directive Registry under Probate Code Section 4800, and registering is voluntary.

You have two ways to use it. Either attach a copy of your signed directive to the Registration of Written Advance Health Care Directive form, or use the form to record where the original is kept. A new registration costs $10. Amending a registration or revoking one carries no fee.

Once you register, the Secretary of State releases the information on request to your health care provider, public guardian, or legal representative, and the request has to state why the information is needed. Registering does not make your details public.

Fees are set by the state and change from time to time, so confirm the current amount with the Secretary of State before you mail anything.

Tip: Registration is a backup, not a delivery system. Hand copies to your agent and your doctor as well, since a hospital will usually look at the paper in front of it first.

1. Decide whether you want an agent, written instructions, or both.
2. Name your agent, plus a first and second alternate if you want cover.
3. Record your end-of-life choices, your wishes on pain relief, and any organ donation instructions.
4. Choose your route: two qualified witnesses, or a notary public.
5. Sign and date, then have your witnesses or notary complete their part.
6. Add the ombudsman or patient advocate witness if you are signing inside a skilled nursing facility.
7. Optionally, file the registration form and the $10 fee with the Secretary of State.

Build your California advance directive now and download it in PDF or Word.

The statutory form runs in four parts, and you can complete as many or as few as you like.

Part 1 is a power of attorney for health care. It names your agent, sets when their authority begins, and can name alternates.

Part 2 holds your own instructions. You choose between prolonging life and letting natural death occur, say what you want for pain relief, and add anything else in your own words.

Part 3 covers organ, tissue, and body part donation after death. Finally, Part 4 designates the physician with primary responsibility for your care.

One limit is worth knowing. Your agent cannot commit you to a mental health facility, and cannot consent on your behalf to convulsive treatment, psychosurgery, sterilization, or abortion.