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FORM 3-1 ADVANCE HEALTH CARE DIRECTIVE

FORM 3-1 ADVANCE HEALTH CARE DIRECTIVE (03/17)California Hospital Association Page 1 of 8 INSTRUCTIONSPart 1 of this form 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.

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. AGENT’S POSTDEATH AUTHORITY: My agent is authorized to make anatomical gifts, authorize an autopsy and direct disposition of my remains,

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