In California, a living will, or “Advanced Health Care Directive” can be registered with the Secretary of State pursuant to California Probate Code Section 4800 et seq. Pursuant to Section 4803, failure to register ”does not affect the validity of any advanced health care directive“.
Information that may the Secretary of State receives is limited to the registrant’s name, social security number, driver’s license number, or other individual identifying number established by law, if any, address, date and place of birth, the registrant’s advance health care directive, an intended place of deposit or safekeeping of a written advance health care directive, and the name and telephone number of the agent and any alternative agent. Information that may be released upon request may not include the registrant’s social security number except when necessary to verify the identity of the registrant.
You can download the “Registration of Written Advanced Health Care Directive” form HERE or print out the Scribd file:
A “Living Will” is a document in which you can specify your health care wishes in case you become incapacitated and cannot make decisions for yourself. In California, the document is known as an Advanced Health Care Directive and the law governing such directives is set forth in California Probate Code Sections 4700 and 4701. It is a good idea to have complete this form so it is availabe to your family members, agents and physicians during a medical crisis.
California residents can download a free PDF fill-in version of the statutory form HERE or print the Scribd version below. The California legislature has prescribed a sample of the form in the California Probate Code so you do not have to pay for it.
The document also allows you nominate one or more health care agents to make decisions for you if you cannot do so yourself. Your agent may make decisions in conjunction with your doctor, such as consenting to certain types of treatment and life support. You can also limit your agent’s authority and specify certain directives such as your preference regarding life support and organ donation.
If you wish, you may register your Advanced Health Care Directive with the California Secretary of State. Registration is OPTIONAL and the document remains valid without registration.
This document is different than a Emergency Medical Services Prehospital Do Not Rescusitate(DNR) form or Physician Orders for Life Sustaining Treatment (POLST). These documents should be executed with caution and in conjunction with advice from licensed physicians and California attorneys. You can download both of these forms for FREE. You do not have to pay for either of these forms.
The Sierra-Sacramento Valley EMS Agency issued a Program Policy Reference No. 823 to deal with the subject of “Do Not Resuscitate”. The policy is effective as of June 2009 and will be reviewed again in february 2012. You can download a copy HERE.
Sacramento County includes the following communities:
Citrus Heights
Elk Grove
Folsom
Galt
Isleton
Rancho Cordova
Sacramento
Antelope
Arden-Arcade
Carmichael
Del Paso Heights
Elverta
Fair Oaks
Florin
Foothill Farms
Gold River
Hagginwood
Herald
La Riviera
Laguna
Locke
Natomas
North Highlands
Orangevale
Parkway-South Sacramento
Rancho Murieta
Rio Linda
Rosemont
Vineyard
Walnut Grove
Wilton
The policy is similar to that of Alameda County’s. You can downlad a FREE advanced health care directive HERE.
Annapolis
Bodega
Bodega Bay
Boyes Hot Springs
Bloomfield
Cazadero
Cloverdale Cotati
Duncan Mills
El Verano
Fetters Hot Springs
Forestville
Fort Ross
Geyserville
Glen Ellen
Graton
Guerneville Healdsburg
Jenner
Lake Sonoma
Kenwood
Monte Rio
Occidental
Ocean Cove Petaluma Rohnert Park
Salmon Creek
Santa Rosa
Sea Ranch
Sears Point
Sebastopol Sonoma Schellville
Stewarts Point
Timber Cove
Two Rock
Valley Ford
Windsor
Effective as of February 5, 2009 the Inland Counties Emergency Medical Agency established criteria for withholding resuscitative measures. You can download the document HERE.
San Bernadino County includes:
Adelanto
Apple Valley
Barstow
Big Bear Lake
Chino
Chino Hills
Colton
Crestline
Fontana
Grand Terrace
Hesperia
Highland
Joshua Tree
Lake Arrowhead
Loma Linda
Lucerne Valley
Montclair
Needles
Ontario Rancho Cucamonga
Redlands
Rialto
Running Springs
San Bernardino Twentynine Palms
Upland
Victorville
Wrightwood
Yermo
Yucaipa
Yucca Valley
Click HERE for relevant selections from the Alameda County Resource Policy Manual
In addition, you can get a copy of the claim form for transfer of base year value to replacement. This form is for use by persons 55 years or older to transfer base value to a new dwelling.
Alameda County includes the following communities:
Alameda, Albany, Berkeley, Dublin, Emeryville, Fremont, Hayward, Livermore, Newark, Oakland, Piedmont, Pleasanton, San Leandro, Union City, Irvington, Township of Washington, Cherryland, Township of Eden
The California Senior Legal Hotline has published a Senior Legal Factsheet titled “Your Health Care: Who Will Decide if You Can’t”, which outlines many of the forms and choices available under California law. You can download the factsheet HERE, which was produced with assistance from the California Endowment, Sierra Health Foundation and the Foundation of the State Bar.
On March 16, 2009, Orange County revised its policy on Do Not Resuscitate Orders and Advanced Health Care Directives (Living Wills). You can download policy #330.51 HERE.
Orange County includes the following cities:
Aliso Viejo, Anaheim, Brea, Buena Park, Costa Mesa, Cypress, Dana Point, Fountain Valley, Fullerton, Garden Grove, Huntington Beach, Irvine, Laguna Beach, Laguna Hill, Laguna Niguel, Laguna Woods, La Habra, Lake Forest, La Palma, Los Alamitos, Mission Viejo, Newport Beach, Orange, Placentia, Rancho Santa Margarita, San Clemente, San Juan, Capistrano, Santa Ana, Seal Beach, Stanton, Tustin,Villa Park, Westminster, Yorba Linda, Coto de Caza, Cowan Heights, El Modena, Eerald Bay, Ladera Ranch, Lemon Heights, Midway City, Modjeska Canyon, Orange Park Acres, Rancho Mission Viejo, Red Hill, Rossmoor, Silverado Canyon, Sunset Beach, Trabuco Canyon and Tustin Foothils
In April 2009, Santa Cruz County adopted policy #1190 to advise EMS personel regarding Do Not Resuscitate Orders, POLST and Advanced Health Care Directives. You can download the document HERE.
Santa Cruz County includes the following cities and unincorporated towns:
Santa Cruz, Capitola, Watsonville, Scotts Valley, Amesti, Aptos, Aptos Hills-Larken Valley, Ben Lommond, Bonnie Doon, Boulder Creek, Brookdale, Corralitos, Davenport, Day Valley, Felton, Freedom, Interlaken, La Selva Beach, Live Oak, Mount Hermon, Opal Cliffs, Rio Del Mar, Soquel, Pasatiempo, and Twin Lakes
Incidents of elder abuse has occurring in a long-term care facility should be reported to the local Long-Term Care Ombudsman, the local law enforcement agency or the Bureau of Medi-Cal Fraud and Elder Abuse. If abuse has occurred anywhere other than in a facility, reports should be made to the local county Adult Protective Services agency or to the local law enforcement agency.
You can download a copy of the Confidential Report used by the California Department of Social Services HERE.
Atherton, Belmont, Brisbane, Burlingame, Colma, Daly City, East Palo Alto, Foster City, Half Moon Bay, Hillsborough, Menlo Park, Millbrae, Pacifica, Portola Valley, Redwood City, San Bruno, San Carlos, San Mateo, South San Francisco, Woodside
This is actually a policy on POLST as well. Download the Contra Costa County policy HERE.
Contra Costa County includes the following:
Alamo, Antioch, Bay Point, Bethel Island, Blackhawk, Brentwood, Byron, Clayton, Concord, Crockett, Danville, Discovery Bay, El Cerrito, El Sobrante, Hercules, Kensington, Knightsen, Lafayette, Martinez, Moraga, Oakley, Orinda, Pacheco, Pinole, Pittsburg, Pleasant Hill, Richmond, Rodeo, San Pablo, San Ramon , Walnut Creek
Los Angeles County Department of Health Services issued a memorandum ref#818 regarding the honoring of Advanced Health Care Directives (Living Wills). Click HERE for the memorandum.
Los Angeles County includes the following communities:
According to FinalChoices.org: “POLST is a physician order that helps give seriously ill patients more control over their end-oflife care. Produced on a distinctive bright pink form and signed by both the doctor and patient, POLST specifies the types of medical treatment that a patient wishes to receive towards the end of life. As a result, POLST can prevent unwanted or medically ineffective treatment, reduce patient and family suffering, and help ensure that patients’ wishes are honored.”
The POLST form includes direction regard resuscitation directions (DNR) as well as: 1) administration of antibiotics and fluids, 2) use of a ventilator and 3) artificial nutrition by tube.
You can download a free copy of the POLST form HERE. The form should be completed by a health care professional. The form is similar to a living will (Advanced Health Care Directive) but it is not the same.
A living will is NOT the same thing as a Do Not Resuscitate Order (DNR). A DNR is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing.
In California, the “Emergency Medical Services Prehospital Do Not Resuscitate (DNR) Form) is an official State document developed by the California EMS Authority and the California Medical Association which, when completed correctly, allows a patient with a life threatening illness or injury to forgo specific resuscitative measures that may keep them alive. Such resuscitative measures include: chest compressions (CPR), assisted ventilation (breathing), endotracheal intubation, defibrillation, and cardiotonic drugs (drugs which stimulate the heart). The form does not affect the provision of other emergency medical care, including treatment for pain, difficulty breathing, major bleeding, or other medical conditions.
You can download the California DNR form HERE. The form should only be executed with the advice of a physician and/or licensed attorney. The California EMS Authority honors the DNR according to specific Guidelines.