Advance Health Care Directive Form
A California Advance Health Care Directive is a very important document that not only funeral homes look for, but most medical facilities. This document allows you to specify what you want when it comes to your personal health. It designates someone of your choice to abide by your wishes or you can allow them to make the decisions for you when you are unable. This also covers funeral and cremation services. The Advance Health Care Directive helps alleviate the stress and burdens placed on your family. Please sit with someone you trust and fill this document out. A living will is a different form of advance directive, in which you can express your preferences for health care treatment. However, a living will does not allow you to appoint an agent to act in your behalf. Be sure all health care providers and Funeral home has a copy.
The two witnesses cannot be listed as a designee
STATEMENT OF WITNESSES: I declare under penalty of perjury under the laws of California (1) that the individual who signed or acknowledged this advance health care directive is personally known to me, or that the individual's identity was proven to me by convincing evidence (2) that the individual signed or acknowledged this advance directive in my presence, (3) that the individual appears to be of sound mind and under no duress, fraud, or undue influence, (4) that I am not a person appointed as agent by this advance directive, and (5) that I am not the individual's health care provider, an employee of the individual's health care provider, the operator of a community care facility, an employee of an operator of a community care facility, the operator of a residential care facility for the elderly, nor an employee of an operator of a residential care facility for the elderly.
Fred Young Funeral Home FD#1944 | 428 N. Cloverdale Blvd. Cloverdale, CA 95425 | Email: firstname.lastname@example.org | Phone: (707) 894-2540
Fred Young Funeral Home FD#2212 | 718 Healdsburg Ave. Suite F, Healdsburg, CA 95446 | Email: email@example.com | Phone: 707-473-8431
Eggen & Lance Chapel FD#240 | 1540 Mendocino Avenue, Santa Rosa, CA 95401 | Email: firstname.lastname@example.org Phone: (707) 545-3747
Santa Rosa Mortuary FD#1779 | 1900 Franklin Ave., Santa Rosa, CA 95404 | Email: email@example.com | Phone: (707) 545-3747