Advance Health Care Directive Instructions

Name a Health Care Agent to speak YOUR OPINION for you (not theirs).

Make your opinion “clear & convincing” by WRITING IT OUT.

You can use the statutory California Advance Health Care Directive form at Probate Code Section 4701 or you may find that the FIVE WISHES form ~ which is also accepted in California ~ is more ‘user-friendly’. You can use examples of what you do want and what you do not want. Say what you really think, in addition to any “legalese”.

You can order the “FIVE WISHES” form from http://www.agingwithdignity.org/5wishes.html
or you can call our office.

You can attach pages to your Advance Health Care Directive.
Ask your Health Care Agent if s/he is willing to serve:

If s/he says “Yes, I’d be delighted!”

then give a copy to your Agent now, while you are well.

If s/he says anything else other than “Yes” ~

look for another Agent.

Contact the Prof. Fiduciary Association of California: at

http://www.pfac-pro.org and at left, click on “Referrals Listings” for members in Northern California, Southern California, and San Diego.

Make a list of all the things your Agent needs to know, including

Birthdate
SSA number
Blood type
Allergies
Broken bones/broken parts, almost broken parts
Attending physician
Specialists
HMO/HMO card/health insurance policy
What are your MEDICAL needs?
What are your PSYCHOLOGICAL needs?
What are your SPIRITUAL needs?
What are your SOCIAL needs?
What are your PREFERENCES? Do you have usual routines?
Favorite foods/Dislikes
Favorite activities/Dislikes
What is unique about you?
What do you want to be remembered for?
Names and addresses of relatives
To the 2d degree (or farther out)
Successor Trustee? Executor?
Location of important documents?
Estate-planning documents?
Insurance policies?
Annuities?
VA discharge papers?
Funeral plans? Where? What? Who? Cremation or Burial?

If you do not want your agent to know some of this information, then maybe this person is not the Right Agent for you.em>

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