MAKE YOUR FREE California Living Will
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What is a California Living Will?
The person making a Living Will is known as the "principal," while the person or entity obtaining permission to carry out the principal's wishes is called the "agent." Designed for residents of California, this Living Will is made for use in Orange County, Los Angeles County, San Diego County, and in all other regions throughout the state. Any California Living Will form from Rocket Lawyer can be edited for your particular situation. As a result of this official document, your medical facilities will have a point of reference for your decisions, and your agent(s) can provide proof that they have the authority to make choices for you.
When to use a California Living Will:
- You're making sure your loved ones aren't put in the position of making important end-of-life healthcare decisions for you.
- You're about to draft a complete estate plan, and want to make sure life-sustaining treatments are covered.
Sample California Living Will
The terms in your document will update based on the information you provide
ADVANCE HEALTH CARE DIRECTIVE
(California Probate Code Section 4701)
EXPLANATION
You have the right to give instructions about your own health care. You also have the right to name someone else to make health care decisions for you. This form lets you do either or both of these things. It also lets you express your wishes regarding donation of organs and the designation of your primary physician. If you use this form, you may complete or modify all or any part of it. You are free to use a different form.
Part 1 of this form is a power of attorney for health care. Part 1 lets you name another individual as agent to make health care decisions for you if you become incapable of making your own decisions or if you want someone else to make those decisions for you now even though you are still capable. You may also name an alternate agent to act for you if your first choice is not willing, able or reasonably available to make decisions for you. (Your agent may not be an operator or employee of a community care facility or a residential care facility where you are receiving care, or your supervising health care provider or employee of the health care institution where you are receiving care, unless your agent is related to you or is a coworker.
Unless the form you sign limits the authority of your agent, your agent may make all health care decisions for you. This form has a place for you to limit the authority of your agent. You need not limit the authority of your agent if you wish to rely on your agent for all health care decisions that may have to be made. If you choose not to limit the authority of your agent, your agent will have the right to:
(a) Consent or refuse to consent to any care, treatment, service or procedure to maintain, diagnose or otherwise affect a physical or mental condition.
(b) Select or discharge health care providers and institutions.
(c) Approve or disapprove diagnostic tests, surgical procedures, and programs of medication.
(d) Direct the provision, withholding, or withdrawal of artificial nutrition and hydration and all other forms of health care, including cardiopulmonary resuscitation.
(e) Make anatomical gifts, authorize an autopsy, and direct disposition of remains.
Part 2 of this form lets you give specific instructions about any aspect of your health care, whether or not you appoint an agent. Choices are provided for you to express your wishes regarding the provision, withholding or withdrawal of treatment to keep you alive, as well as the provision of pain relief. Space is also provided for you to add to the choices you have made or for you to write out any additional wishes. If you are satisfied to allow your agent to determine what is best for you in making end-of-life decisions, you need not fill out Part 2 of this form.
Part 3 of this form lets you express an intention to donate your bodily organs and tissues following your death.
Part 4 of this form lets you give the authority to your agent to authorize autopsy and disposition of your remains.
Part 5 of this form lets you give the authority to your agent to signed forms under HIPAA that refers to the release of your medical records.
Part 6 of this form lets you designate a physician to have primary responsibility for your health care. After completing this form, sign and date the form at the end. The form must be signed by two qualified witnesses or acknowledged before a notary public. Give a copy of the signed and completed form to your physician, to any other health care provider you may have, to any health care institution at which you are receiving care and to any health care agents you have named. You should talk to the person you have named as agent to make sure that he or she understands your wishes and is willing to take the responsibility.
You have the right to revoke this advance health care directive or replace this form at any time.
PART 1
POWER OF ATTORNEY FOR HEALTH CARE
. DESIGNATION OF AGENT. I, , residing at , , , do hereby designate the following individual as my agent to make health care decisions for me:
Agent:
Name: |
Address: |
, |
Phone: | Home: Work: |
. AGENT'S AUTHORITY. My agent is authorized to make all health care decisions for me, including decisions to provide, withhold or withdraw artificial nutrition and hydration and all other forms of health care to keep me alive
. WHEN AGENT'S AUTHORITY BECOMES EFFECTIVE. My agent's authority becomes effective when my primary physician determines that I am unable to make my own health care decisions
. AGENT'S OBLIGATION. My agent shall make health care decisions for me in accordance with this power of attorney for health care, any instructions I give in Part 2 of this form and my other wishes to the extent known to my agent. To the extent my wishes are unknown, my agent shall make health care decisions for me in accordance with what my agent determines to be in my best interest. In determining my best interest, my agent shall consider my personal values to the extent known to my agent.
PART 2
INSTRUCTIONS FOR HEALTH CARE
If you are satisfied to allow your agent to determine what is best for you in making end-of-life decisions, you need not fill out this part of the form.
. END-OF-LIFE DECISIONS. I direct that my health care providers and others involved in my care provide, withhold or withdraw treatment in accordance with the choice I have initialed below:
. ARTIFICIAL NUTRITION AND HYDRATION. Artificial nutrition and hydration must be provided, withheld or withdrawn in accordance with the choice I have made in paragraph
. RELIEF FROM PAIN.
PART 3
DONATION OF ORGANS AT DEATH
PART 4
AUTOPSY AND DISPOSITION ON REMAINS
. Upon my death, I give the authority to my agent to authorize an autopsy make determinations for disposition of my remains.
PART 5
AUTHORIZATION TO SIGN FORMS UNDER HIPAA
. With this document I authorize my agent to sign all forms required under HIPAA that refer but are not limited to the release of my medical records.
PART 6
PRIMARY PHYSICIAN
. I designate the following physician as my primary physician:
Physician:
Name: |
Address: |
, |
Phone: |
If a primary physician is not selected under part 6, then I request that the rules of California Medical Association be applied for the identification of my primary physician.
PART 7
. EFFECT OF COPY. A copy of this form has the same effect as the original.
. SIGNATURE.
Declarant Signature: | _______________________________________ |
Name: |
Address: |
, |
Date: | _____________________ |
NOTICE: SPECIAL RULES APPLY IF YOU ARE A RESIDENT OF A SKILLED NURSING FACILITY. IF YOU RESIDE IN SUCH A FACILITY, THIS DOCUMENT MUST BE SIGNED BY A PATIENT ADVOCATE OR OMBUDSMAN. IF YOUR DOCUMENT IS BEING WITNESSED BY TWO WITNESSES, ONE OF THOSE WITNESSES MUST BE THE ADVOCATE OR OMBUDSMAN WHO SIGNS ALL WITNESS STATEMENTS. IF YOUR DOCUMENT IS BEING NOTARIZED, THE ADVOCATE OR OMBUDSMAN MUST SIGN THE SPECIAL WITNESS REQUIREMENT SECTION.
. STATEMENT OF WITNESSES: [If you are a resident in a skilled nursing facility, a patient advocate or ombudsman must sign this statement as one of your two 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,
(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, and
(6) that I am an adult.
Witness Signature: | ________________________________________ |
Date: | _________________________ |
Witness Signature: | ________________________________________ |
Date: | _________________________ |
. ADDITIONAL STATEMENT OF WITNESSES. At least one of the above witnesses must also sign the following declaration. [If you are a resident in a skilled nursing facility, the patient advocate or ombudsman must sign this statement.]
I further declare under penalty of perjury under the laws of California that I am not related to the individual executing this advance health care directive by blood, marriage, or adoption, and to the best of my knowledge, I am not entitled to any part of the individual's estate upon his or her death under a will now existing or by operation of law.
Witness Signature: | ________________________________________ |
Name: | ________________________________ |
Address: | ________________________________ |
________________________________ |
________________________________ |
Date: | _________________________ |
PART 8
. SPECIAL WITNESS REQUIREMENT.
The following statement is required only if you are a patient in a skilled nursing facility - a health care facility that provides the following basic services: skilled nursing care and supportive care to patients whose primary need is for availability of skilled nursing care on an extended basis. The patient advocate or ombudsman must sign the following statement:
STATEMENT OF PATIENT ADVOCATE OR OMBUDSMAN: I declare under penalty of perjury under the laws of California that I am a patient advocate or ombudsman as designated by the State Department of Aging and that I am serving as a witness as required by Section 4675 of the Probate Code.
I further declare:
(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,
(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,
(6) that I am an adult, and
(7) that I am not related to the individual executing this advance health care directive by blood, marriage, or adoption, and to the best of my knowledge, I am not entitled to any part of the individual's estate upon his or her death under a will now existing or by operation of law.
Witness Signature: | ________________________________________ |
Name: | ______________________________ |
Address: | ______________________________ |
City, State, Zip: | ______________________________ |
When you complete this form, you are advised that you may not regard this form as completed with the assistance of an attorney.
California Living Will FAQs
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How do I write a Living Will in California?
It is very easy to set forth your medical wishes using a free California Living Will template from Rocket Lawyer:
- Make the document - Answer a few general questions,, and we will do the rest
- Send or share - Discuss the document with your healthcare agent(s) or get legal advice
- Sign and make it legal - Required or not, witnesses/notarization are encouraged
This solution, in many cases, will be much less expensive and less time-consuming than working with a conventional law firm. If needed, you can start this Living Will on behalf of an elderly parent, a spouse, or another relative and then have them sign when ready. Keep in mind that for this document to be valid, the principal must be an adult who is mentally competent when they sign. If the principal has already been declared legally incompetent, a conservatorship may be required. When dealing with this situation, it's important to work with an attorney .
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Who should make a Living Will?
Anyone who is over 18 should have a Living Will in place. Even though it is painful to think about, a time might come when you can no longer make your own health care decisions. Common situations where it may be useful to make or update your Living Will include:
- You are aging or dealing with ongoing health issues
- You reside in or intend to move into a care facility
- You are expecting to undergo an in-patient procedure requiring anesthesia
- You have been given a terminal diagnosis
Whether your California Living Will is being drafted as part of a long-term plan or created in response to a recent change in your health, notarization and witnesses can often help to protect your document if its authority is challenged. Please keep in mind that, in California, a Living Will is not valid during pregnancy.
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Should I work with a lawyer for my Living Will in California?
Making a Living Will is typically simple, but you or your agent(s) might need legal advice. Locating a legal professional to check your California Living Will can be relatively time-consuming. A more cost-effective way to double-check your document is through the Rocket Lawyer attorney network. With a Premium membership, you can get your document reviewed or send any questions. As always, you can rest assured that Rocket Lawyer is by your side.
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How much would it traditionally cost for an attorney to help me make a Living Will in California?
The fees associated with finding and hiring a law firm to draft a Living Will could total anywhere between $200 and $1,000, depending on where you are located. When you use Rocket Lawyer, you are not just filling out a Living Will template. If you ever need help from a lawyer, your Premium membership offers up to 40% in savings when you hire an attorney from our network.
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Is anything else required after drafting a California Living Will?
When you're done making the document using Rocket Lawyer, you will be able to access it at any time and place. You may also perform any or all of the following actions with your document: editing it, printing it, and/or signing it. Alongside each California Living Will form, there is a list of next steps to take once your document is completed. You should send a copy of the fully signed document to your agent(s), care providers, and other impacted parties.
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Does a Living Will need to be notarized or witnessed in California?
The specifications will vary by state; however, in California, your document requires notarization or the signatures of two witnesses. Witnesses to a Living Will should not be any employer or operator of the health care or community/residential care facility providing your care. Only one of the witnesses may be someone who is an heir, a beneficiary, or otherwise legally related to you (such as a spouse, adopted child, or family member.) As a basic standard, witnesses should be 18 years old or older, and none should also be your agent.