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A California Advance Health Care Directive Includes Two Decisions

For Californians comparing a medical power of attorney in California with a living will in California, the first thing to understand about this state is that they are included in the same document.

Part 1 is your power of attorney for health care. It names the agent who will make medical decisions on your behalf. Part 2 is your individual health care instruction and the specific treatment wishes most people mean when they say “living will.”

If you are satisfied to let your agent decide what is best for you, California law does not require you to complete Part 2 at all.

California is unique because in most other states, your agent’s authority normally begins when your primary physician determines you can no longer make your own decisions. However, in California, the statutory form at Probate Code Section 4701 lets you check a box making that authority effective immediately, while you remain fully capable and fully in control of your own care.

And you are not locked into the state’s form. California law allows you to complete or modify any part of the statutory form or to use a different form entirely.

MIDEO helps residents of the Golden State bring those pieces together. A video advance directive in California pairs your legally compliant written directive with your own explanation of what you want, why you want it, and how your agent should act when the moment arrives.

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In California, Your Health Care Agent Has More Authority

California law makes your health care agent powerful.

Unless you specifically limit their authority, the agent named in Part 1 of your directive, holds broad decision-making power on your behalf. Your agent can consent to or refuse any care, treatment, service, or procedure. If you don’t do anything, your agent has full authority.

That makes the conversation with your agent a big deal. MIDEO makes that conversation easier. A video advance directive in California through MIDEO lets you explain your choices and your reasoning directly to the person who will act on them. Your agent can pull it up by QR code any time, including at the bedside.

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You Can Change Who Speaks for You During a Hospital Stay

California gives you flexibility when the person you need during a particular hospitalization is not the person named in your directive.

Under California law, you can personally tell your healthcare provider that you want another adult to serve as your surrogate for that episode of care. The hospital must record that designation in your medical record.

This can matter when:

• Your regular health care agent lives out of state
• Your agent cannot get to the hospital quickly
• A spouse, partner, adult child, or trusted friend is with you during a particular procedure
• You want someone who understands the medical problem you are currently facing
• Your usual agent is temporarily unavailable
• You are receiving treatment far from home

But you should know that during that period, the temporary surrogate you designate can take priority over the agent already named in your medical power of attorney in California.

The designation is temporary. Unless you choose a shorter period, it generally lasts for the current course of treatment or illness, the hospital stay in which you made the designation, or 60 days — whichever is shorter. Naming that temporary surrogate does not automatically revoke the agent in your existing advance directive.

This Flexibility Can Also Cause Confusion

The flexibility that California allows can be extremely useful. However, it can also create confusion if your family does not understand who you intended to speak for you and why.

MIDEO gives both your long-term agent and anyone you intentionally choose for a particular medical situation access to the reasoning behind your decisions. Your video advance directive in California lets them hear what you want directly from you, while the signed California directive identifies the legal structure behind those wishes.

In California, who speaks for you can sometimes change. What you want them to say should remain clear.

MIDEO Coordinates Every Part of Your California Advance Directive

There is no point in having a bunch of documents that aren’t coordinated and stored in one place. An advance healthcare directive in California should never depend entirely on one portal having the right document at the right moment.

The MIDEO process helps you work through the decisions that otherwise end up scattered across forms and hospital systems, including:

• The treatments you would accept, refuse, or want only under specific conditions
• Who should serve as your health care agent, and who your alternate agent should be
• Whether your agent’s authority begins immediately or only after your physician determines you cannot decide for yourself
• How much discretion your agent has when the situation is not one you anticipated
• Whether the instructions in Part 2 of your directive actually support the authority you gave in Part 1
• Whether a POLST is appropriate for you at all, or whether an advance directive alone is the right tool right now
• Your wishes about organ and tissue donation
• Whether your donor registration, your directive, and anything already filed with a health system reflect what you want today
• Who needs an updated copy when your choices change

Between the statewide POLST eRegistry, the records held by whichever health systems have treated you, and whatever paperwork exists at home, a Californian’s wishes can end up documented in several places at once. Most of these are created at different times, by different people, and in different words. When those versions disagree, someone has to decide which one governs.

MIDEO brings those decisions into a single conversation. A video advance directive in California lets you explain your reasoning, why you made each choice, and what your agent should do when the situation turns out to be more complicated than any form anticipated.

When an Old Copy Becomes a New Problem

Creating an advance healthcare directive in California is a great first step. But, if you aren’t diligent, multiple versions can be stored in different places, including:

• Your current advance directive in California
• The health care agent and alternate agent you named
• Copies stored with your primary doctor or specialists
• Directives uploaded into different hospital-system portals
• A California POLST if serious illness or frailty later makes one appropriate
• Information registered with California’s Advance Health Care Directive Registry
• Organ and tissue donation instructions
• Older copies still held by family members

Many California families discover that their loved one’s POLST called for aggressive treatment while an existing advance directive said the opposite.

MIDEO helps make the current plan easier to identify and understand. Your signed directive is paired with a video advance directive in California where you explain the reasoning behind your choices, and the current MIDEO record remains accessible through your secure QR code.

Your wishes can change. The dangerous part is when your paperwork does not change with them. With MIDEO, you don’t have to worry about that.

California’s Wildfires and Evacuations

California also has a portability problem that has nothing to do with choosing a health system.

During the January 2025 Southern California wildfires, state officials coordinated transfers of more than 130 long-term-care residents and worked with roughly 120 facilities affected by evacuation pressures, staffing problems, and increased demand. Many hospitals had to establish reunification phone lines afterward because families could not locate their own relatives.

Now consider where most Californians keep their advance directive. In a drawer at home that is now under an evacuation order.

A wildfire can change where a patient receives care. The hospital that normally holds the patient’s records may no longer be where the patient is treated and family members may evacuate in a different direction.

MIDEO keeps the patient’s current written directive and video connected to the patient through a secure QR code.

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Californians Need Advance Directives That Work Across 800 Miles and Eight Health Care Markets

California runs more than 800 miles north to south from the Oregon border to Mexico. It also has the most consolidated hospital landscape in the country concentrated in the hands of a few enormous systems.

Kaiser Permanente operates more than 9,400 staffed beds in California, which is more than any other system. UC Health runs roughly 6,665 and CommonSpirit holds about 5,680.

Other healthcare systems include:

• Sutter
• Providence
• Stanford
• Cedars-Sinai
• Sharp
• Scripps
• Adventist Health
• MemorialCare
• Hoag

That means a Californian can easily be treated by an organization that has never seen a single page of their records. Here’s a break down based on regions:

Los Angeles County

Los Angeles County alone holds 9.9 million residents and the city may be California’s clearest example of healthcare fragmentation. Recent California Health Care Foundation research found that only Kaiser Permanente and Cedars-Sinai individually accounted for more than 10% of acute-care discharges, while the four largest systems together accounted for only 39%. A single patient here may move through:

• Kaiser Permanente Southern California
• Cedars-Sinai
• UCLA Health
• Keck Medicine of USC
• Providence Southern California
• Dignity Health
• Los Angeles General Medical Center and the county system

LA County is also one of the most linguistically diverse places on earth. In fact, the people living here together speak 244 languages. A video lets your intent come through in your own voice, in your own language, without a document standing in between.

MIDEO keeps the current signed directive and the patient’s video connected to a persistent QR code that can be opened from any device.

Orange County and the South Bay

Orange County combines dense specialty care with some of the largest retirement communities in the western United States. In this location, patients are often in multiple hospital systems, including:

• Hoag
• UCI Health
• Providence Mission and St. Joseph
• MemorialCare
• Kaiser Permanente

Many residents here retired to California from somewhere else or retired within California and left their longtime physician behind in another county. Their adult children are frequently out of state entirely. A medical power of attorney in California only helps if the person named in it can be reached and knows what you actually wanted.

San Diego County

San Diego is a market with a large military and veteran population, and a border region where care crosses jurisdictions. Most people in this area seek care at these healthcare systems:

• Sharp HealthCare
• Scripps Health
• UC San Diego Health
• Palomar Health
• Kaiser Permanente

Military families move constantly (every 2.5 years on average), and care may be delivered at a military treatment facility or VA. A directive tied to any one of those systems might not be available at civilian hospitals. MIDEO travels with the patient.

Riverside and San Bernardino

Riverside and San Bernardino counties are among the fastest-growing regions in California. Riverside County alone is home to over 2 million people. Furthermore, desert communities around Palm Springs house a large seasonal and retiree population. People in these counties usually utilize these hospital systems:

• Loma Linda University Health
• Kaiser Permanente
• Riverside University Health System
• Dignity Health
• Eisenhower Health

San Francisco Bay Area

The Bay Area spreads across nine counties and six major competing systems. These include:

• Sutter Health
• UCSF Health
• Stanford Health Care
• Kaiser Permanente Northern California
• John Muir Health
• Zuckerberg San Francisco General and the county systems

Someone living in Oakland may have a primary care physician in one system, a specialist in another, and end up in the emergency department of a third. Each keeps its own record. A directive filed in one of them isn’t available at a different healthcare system.

Sacramento and Northern California

Sacramento functions as the referral hub for an enormous rural catchment reaching to the Oregon border. The health systems here include:

• UC Davis Health
• Sutter Health
• Dignity Health
• Kaiser Permanente
• Adventist Health

Patients arrive here by transfer from small hospitals hours away, often unconscious, often without records following them in real time. This is exactly the moment a QR code outperforms paper advance directives.

The Central Valley

Fresno, Bakersfield, Stockton, Modesto, and the agricultural communities usually are part of these healthcare systems:

• Community Health System
• Adventist Health
• Kaweah Health
• Saint Agnes Medical Center
• Valley Children’s Healthcare
• Sutter and Dignity facilities

Hospital capacity can change here in ways patients do not expect. Madera Community Hospital closed in 2023 and reopened in 2025, illustrating how quickly the available care network itself can change.

The Central Coast

The Central Coast stretches across communities that may rely on very different regional systems, including:

• Cottage Health
• Dignity Health Central Coast
• Salinas Valley Health
• Montage Health
• Natividad
• Marian Regional Medical Center
• Other community hospitals

For someone living between Monterey, San Luis Obispo, Santa Barbara, or one of the smaller communities along the coast, specialized treatment may eventually involve a different organization or a larger referral center.

Rural Northern California

Patients across Humboldt, Del Norte, Shasta, Lassen, Siskiyou, Mendocino, Lake, and surrounding counties may depend on:

• Providence
• Mercy Medical Center Redding
• Shasta Regional Medical Center
• Enloe Health
• Adventist Health
• Critical access and independent rural hospitals

Some communities rely on small hospitals with limited acute-care capacity, making transfers a daily part of complex illness or trauma.

When the receiving physician has never met the patient and the health care agent may be hours away, accessibility and clarity become essential. That’s what MIDEO helps with.

California Advance Directive FAQs

I don’t trust my family to make medical decisions for me. Do I need a medical power of attorney in California?

Yes, and to make sure you are the one making your medical decisions, you need more than that.

In California, what people often search for as a medical power of attorney in California is generally created through an Advance Health Care Directive. You can name a spouse, partner, relative, or trusted friend to make health care decisions if you cannot make them yourself.

If you do not name someone and later lose capacity, California law allows a healthcare provider or facility to select a surrogate if there is no already recognized decision-maker available. That person might be your spouse or domestic partner, adult child, parent, sibling, grandchild, another relative, or even a close personal friend who knows your values.

An advance directive in California lets you make that choice before someone at the hospital has to make it for you.

How do I make an advance healthcare directive in California legally valid?

You don’t need an attorney to create an advance healthcare directive in California.

For a written directive, California requires it to be dated and signed, and then either acknowledged before a notary or signed by two qualified adult witnesses

If you use witnesses, neither can be the health care agent you appointed, your healthcare provider, or certain people employed by facilities providing your care. At least one witness must also be unrelated to you and not entitled to inherit from your estate.

If you are living in a skilled nursing facility when you execute the directive, a patient advocate or long-term-care ombudsman must also witness it. That requirement applies even if you use notarization. So, if you are helping a parent complete a living will in California after they enter skilled nursing, do not assume that getting the document notarized finalizes the document.

If I signed a living will in California, will the hospital be able to find it?

Probably not. And we realize that that is probably not the answer that you want to hear. But it is one of the major weaknesses surrounding traditional advance care planning.

California does have an Advance Health Care Directive Registry, but registering is voluntary. Registration currently requires submitting paperwork to the Secretary of State, and authorized requests for information from the registry must be made in writing.

You can also give copies to your health care agent, doctors, attorney, and family. Unfortunately, that doesn’t guarantee that the physician attending to you during an emergency will be able to find it.

When you choose MIDEO for your video advance directive in California your directive is paired to a secure QR code that can be pulled up by a physician in seconds. Anytime you update your plan, the plan that is pulled up via the QR code is updated as well.

Is a California POLST the same as an advance directive or living will?

No, and confusing these documents can have serious consequences.

An advance directive in California is appropriate for adults planning ahead. It lets you name your health care agent and document the medical choices and values you want considered if you cannot communicate.

A California POLST is an immediately actionable medical order primarily intended for people with serious, chronic, progressive, or terminal illness or significant medical frailty.

A POLST is not for everyone and does not replace an advance health care directive.

Some people eventually need both.

Can a video advance directive in California replace my written Advance Health Care Directive?

It doesn’t replace it. Think of it this way… video is what makes your written advance directive better.

California provides specific requirements for executing a legally sufficient written or electronic Advance Health Care Directive. MIDEO pairs that compliant document with you on video explaining the decision yourself.

The written directive establishes the legal instructions. The video supplies context when a real medical situation requires it.

Does an advance directive need to be notarized in California?

No, notarization is optional.

Under Probate Code Section 4673, your directive is legally sufficient if it is dated, signed, and either acknowledged before a notary public or signed in front of at least two qualified adult witnesses.

What’s the difference between a living will and an advance directive in California?

In most states these are two separate documents. In California they are two halves of the same one.

California uses a single instrument called the Advance Health Care Directive. Part 1 is your power of attorney for health care. Part 2 is your individual health care instruction, which is the part most people mean when they say living will.

So if you’re searching for a standalone California living will or a separate California medical power of attorney, you won’t find it. You’re looking for something that doesn’t exist here in this state as its own form.

Who makes decisions for me in California if I don’t have a directive?

Most states have a fixed statutory hierarchy — spouse, then adult children, then parents, then siblings. California deliberately rejected that model. Under Probate Code Section 4712, added by AB 2338 and effective in 2023, a health care provider or a designee of the health care facility may choose a surrogate to make decisions on your behalf as appropriate to the situation. The legislature considered a rigid family hierarchy and decided against it, reasoning that families vary too much.

So know this loud and clear… without a directive, the person who speaks for you in California is selected by the facility treating you.

Furthermore, a patient can verbally designate a surrogate during a hospital admission, and that oral designation can take priority over a formally appointed agent for a limited period.

I registered my directive with the California Secretary of State. Isn’t that enough?

No, it’s not enough. That registry is genuinely useful, but you need to understand exactly what it does.

Registration is voluntary and does not affect whether your directive is valid. What it does is store either your directive or information about where it’s located and issue you a wallet card. If you’re admitted unconscious somewhere unfamiliar, emergency personnel can follow the instructions on that card to request information from the Secretary of State.

That’s a real improvement over paper in a drawer. But notice how many steps a medical team has to go through. They aren’t going to have enough time to go through all of that if you are laying on a table in the ER in ventricular fibrillation.

MIDEO unblocks all of the road blocks. In under 5 seconds, the clinician can scan your QR code and have instructions stated by you about how you want to be treated.

Will my directive work if I’m treated outside my usual health system?

Yes… but that is if the hospital system treating you can find your advance directive. MIDEO is retrievable by QR code anywhere, on any network, in any state — which is the whole reason our team created it.

Your California Advance Directive Should Be Ready Wherever an Emergency Happens

With MIDEO, you state your wishes on video and pair them with a legally compliant California Advance Health Care Directive under Probate Code Section 4670 and following. It is retrievable by QR code at any hospital, on any network, in any state.

The entire process takes less than an hour. California physicians already refer their patients to us. And in California, MIDEO is fully covered, often with no out-of-pocket cost to you at all.

Create a video advance directive in California that gives your health care agent and your clinicians clear direction at the moment you cannot speak for yourself.

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