Advance Health Care Directive

It is often difficult for individuals to think about the care and treatment they want in the event they are incapable of making their own health care decisions. However, completing an Advance Health Care Directive (AHCD) is important for all individuals over 18 years of age as they may unexpectedly be in a position where they cannot speak for themselves, such as an accident or severe illness.

An AHCD allows individuals to appoint an agent who has power of attorney to make care and treatment decisions on their behalf, and give instructions about their health care wishes.

The AHCD form is available below, and at PAMF's Community Health Resource Centers at the Fremont Center, Dublin Center and the Palo Alto Clinic. Copies of the completed form should be given to each person named as agent, or proxy, and to an individual’s primary care physician.

Individual 45-minute appointments with specially-trained volunteers are also available at the Palo Alto Clinic and Fremont Center. To schedule an appointment, please call the Education Division at (650) 853-2960.

• California Advance Health Care Directive Form (Acrobat format) -- print and complete
  
• Directiva Por Anticipado De La Atencion De La Salud -- Spanish version (Acrobat format)
  

Once you have completed this form, please take it to your primary care physician so that it can be placed in your medical record.