California Advance Directive: Agent, Signing, and Storage

A California advance health care directive is a written document that names someone to make medical decisions for you if you can’t, records your treatment wishes, or both. Any California adult with the capacity to understand the decision can create one, and it costs nothing beyond an optional notary fee of up to $15. To be legally valid, the document must be dated, signed, and either notarized or witnessed by two qualifying adults.¹

What the Document Actually Does

The directive combines two tools into one form under California’s Health Care Decisions Law.² You can use either part or both.

A power of attorney for health care, which designates an agent (sometimes called a proxy) with legal authority to make medical decisions on your behalf when you can no longer make them yourself. You can also authorize the agent to handle personal-care matters like where you live and who provides day-to-day help.²
Individual health care instructions, which record your specific treatment preferences: whether you want life-prolonging measures, how you feel about artificial nutrition, and similar questions. These can be written or oral, and you can limit them to activate only under certain conditions.³

When both parts exist, your agent must follow your written instructions. If a situation isn’t covered, the agent decides based on what they know about your values. Only when there’s no guidance at all does the agent fall back on their own judgment of your best interest.

Who Can Create One

You must be 18 or older⁴ and have the capacity to understand what you’re signing. Capacity here means you can grasp the nature of the decision, weigh its benefits and risks, and communicate a choice.⁵ The law presumes you have this capacity, and anyone claiming otherwise carries the burden of proving it.⁶ A doctor or relative who disagrees with your choices can’t block you from creating a directive on that basis.

What to Put in the Form

California publishes an official statutory form in Probate Code Section 4701, but you aren’t required to use it. Any written document that meets the execution rules is valid.³ The statutory form is free, widely accepted by hospitals, and organized to cover the decisions that matter most, so using it avoids arguments about legal sufficiency.

The form walks through several sections:

Agent designation. Full legal name, address, and phone numbers for your primary agent and at least one alternate who steps in if your first choice is unavailable.
Treatment preferences. Whether you want to prioritize extending your life as long as possible or focus on comfort care, and whether you want artificial nutrition and hydration if your condition is terminal or you’re permanently unconscious.
Primary physician. The name and contact information for the doctor you want overseeing your care.
Organ and tissue donation. Whether you want to donate, any limitations on what can be donated, and whether donation is authorized for transplant, research, or both.

Specificity protects you. Language like “no heroic measures” means different things to different people. Spell out whether you want CPR attempted, whether you’d accept a ventilator for a short trial, or whether you want comfort-focused care only.

Choosing Your Health Care Agent

Your agent will stand in your shoes when you can’t communicate. Pick someone who knows your values, can handle pressure from medical staff and family, and will actually follow your wishes even when those wishes are hard.

California restricts who can serve. Your supervising health care provider and employees of the facility where you receive care generally cannot act as your agent.⁷ The same rule applies to operators and employees of community care facilities and residential care facilities for the elderly. One exception: if the employee is related to you by blood, marriage, adoption, or is your registered domestic partner, they can still serve, as long as they aren’t your supervising provider.

Unless you write in specific limitations, your agent gets broad authority, essentially the same decision-making power you would have. That includes choices about life-sustaining treatment, organ donation, autopsy, and disposition of your remains after death.³ If that scope feels too wide, you can carve out specific decisions to retain or exclude in the space the form provides.

Signing It the Right Way

A California directive needs three things to be legally valid: the date you signed it, your signature (or another adult’s signature on your behalf, in your presence and at your direction, if you physically cannot sign), and either notarization or two qualifying witnesses.¹

The Witness Route

If you use witnesses, both must be adults, and the law disqualifies several categories of people:⁸

The person you named as your health care agent
Your health care provider or any of their employees
Any operator or employee of a community care facility or residential care facility for the elderly

At least one of your two witnesses must be someone who is not related to you by blood, marriage, or adoption and who would not inherit from your estate under your current will or under intestacy law.⁸ The rule is meant to guarantee at least one witness with no personal stake in your medical decisions or your death.

The Notary Route

You can skip witnesses entirely by having a notary public acknowledge your signature. A California notary can charge up to $15 per signature. You need to appear in person, since California does not currently allow remote online notarization for these documents.

If You Live in a Skilled Nursing Facility

Residents of a skilled nursing facility face an extra requirement that people frequently miss. A patient advocate or ombudsman designated by the California Department of Aging must witness the document.⁹ The ombudsman signs either as one of the two required witnesses or as a third witness alongside a notary. Without that signature, the directive is invalid. Contact the facility’s social worker or the local Long-Term Care Ombudsman program to schedule the visit, and don’t leave it to the last minute.

Where to Store It and Who Gets Copies

A directive nobody can find is a directive that doesn’t work. After signing, give copies to:

Your health care agent and any alternate agents
Your primary physician, who will add it to your medical record
Any hospital or clinic where you regularly receive care
Close family members who might be present during a medical emergency

Keep the original somewhere secure but accessible. A locked safe deposit box is a common mistake because it can be impossible to open during an emergency. A fireproof home safe a family member can access, or a clearly labeled folder in a known location, works better. A wallet card noting that you have a directive, with your agent’s name and phone number, helps emergency responders reach the right person.

The California Secretary of State runs a voluntary Advance Health Care Directive Registry where you can file your directive or a notice indicating where it’s stored.¹⁰ The filing fee is $10 for a new registration, with no fee for amendments or revocations of a previously filed registration.¹¹ Registration is optional and doesn’t affect legal validity; it just gives medical providers another way to locate the document.

Changing or Revoking Your Directive

Circumstances change, and the rules for undoing your directive depend on which part you’re changing.

To revoke your agent’s authority, you must either sign a written statement or personally tell your supervising health care provider.¹² A remark to a family member isn’t enough. The revocation has to reach the provider who would act on the directive.

To revoke any other part, including your treatment instructions, donation preferences, or physician designation, you can do so at any time and in any manner that clearly communicates intent.¹² A verbal statement, destroying the document, or writing “revoked” across the page all work.

Divorce or annulment automatically revokes your former spouse’s agent designation by operation of law.¹³ If you remarry that same person, the designation is revived. Even so, execute a new directive naming someone else if you don’t want your ex to serve.

When updating rather than fully revoking, the cleanest approach is a brand-new directive. The most recently dated document controls. Retrieve and destroy old copies to avoid confusion, and distribute the replacement to everyone who had the previous version.

An Advance Directive Isn’t a POLST

An advance directive and a POLST (Portable Medical Orders) form serve different populations and carry different legal weight. An advance directive is a planning document for anyone who wants to record future wishes. A POLST is a set of medical orders for people who are seriously ill, have advanced frailty, or have a life expectancy of roughly one to two years or less.¹⁴

The practical difference matters in an emergency. Paramedics and EMTs are trained to stabilize patients and cannot honor an advance directive in the field. They can and must honor a POLST, because it’s a physician-signed medical order rather than a patient-created planning document. If you have a terminal illness and want to avoid resuscitation or hospital transport, you need a POLST alongside your advance directive. A POLST must be completed and signed by your health care provider after a conversation about your goals of care, and a provider can decline to sign one for a healthy patient because the form isn’t designed for general advance planning.

What Happens If You Don’t Have One

If you become incapacitated without a directive, California law provides a default hierarchy of people authorized to make health care decisions for you, generally starting with your spouse or registered domestic partner, followed by adult children, parents, and siblings. That hierarchy doesn’t account for your actual relationships or values. The relative with legal standing to decide might be someone you haven’t spoken to in years, and if family members disagree, the decision can end up in court. Creating a directive while you’re healthy takes less than an hour and costs nothing beyond a possible notary fee. Skipping it shifts the burden to the people around you at the worst possible moment.

1
California Legislative Information. California Code Probate Code 4673
2
California Legislative Information. California Code Probate Code 4671
3
California Legislative Information. California Code Probate Code 4701
4
California Legislative Information. California Code Family Code 6501
5
California Legislative Information. California Code Probate Code 4609
6
California Public Law. California Code Probate Code 4657
7
California Department of Health Care Services. California Code Probate Code 4600-4678, 4695-4698, and 4735-4736
8
California Legislative Information. California Code Probate Code 4674
9
California Legislative Information. California Code Probate Code 4675
10
California Secretary of State. Advance Health Care Directive Registry
11
California Secretary of State. Forms and Fees
12
California Legislative Information. California Code Probate Code 4695
13
California Legislative Information. California Code Probate Code 4697
14
Coalition for Compassionate Care of California. POLST Model Policy – Outpatient Palliative Care Services and Hospice Agencies