Advanced Directive

Advanced Directive Flyer
ADULT PATIENTS ONLY
An Advanced Health Care Directive (AHCD) lets you have a say about how you want to be treated if you get very sick. Please ask a CMC front desk team member for a copy of the California AHCD packet.
Patient Acknowledgement of Advanced Health Care Directive (AHCD) Information Received
I have been informed of my right to formulate an AHCD.

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I have been given information on how to complete an AHCD and available resources to assist me.

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I do not want information at this time.

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I understand that I am not required to have an AHCD in order to receive medical treatment at this health care facility.

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I understand that the terms of any AHCD that I have executed will be followed by the health care facility and my caregivers to the extent permitted by law and if a copy is available to review. I will provide a copy to be part of my health record. If a copy of my AHCD is not available, I understand that life sustaining treatment will be provided should an emergency occur.

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I have an executed AHCDI do not have an executed AHCD
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ADULT PATIENTS ONLY