Advance Health Care Directive
An Advance Health Care Directive is the best way to make sure that your wishes are known and considered if, for any reason, you are unable to speak for yourself. By completing a form called an "Advance Health Care Directive," California law allows you to do either or both of two things: First, you may appoint another person to be your "agent." This person (who may also be known as your "attorney-in-fact") will have legal authority to make decisions about your medical care if you become unable to make these decisions for yourself. Second, you may write down your wishes in the Advance Health Care Directive form—for example, a desire not to receive treatment that only prolongs the dying process if you are terminally ill. Your doctor and your agent must follow your lawful instructions. Even though you do not have to appoint an agent, the California Medical Association (CMA) recommends that you do so. Then there will be someone you trust to actively participate in the decisions involving your health care.
Physician Orders for Life-Sustaining Treatment
(POLST) Form in English (pdf)
(POLST) Form in Spanish (pdf)
The Spanish translation of the California POLST form is for educational purposes only to be used when discussing a patient’s wishes documented on the POLST form. The signed POLST form must be in English so that emergency personnel can read and follow the orders.
Medical Record Request
To request a copy of your medical records, please click on the link below to open the Authorization for the Use and Disclosure of Protected Health Information form. Please download, print, and fill out the form and submit by fax or in person to the HDH Medical Records Department. For more information, please contact Diana Shaw at (707) 431-6475.
Medical Records Department FAX: (707) 431-6575