Advance Health Care Directive

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Download Colorado’s Advance Health Care Directive

You can download and print form to fill out with a pen, or save it to your computer and type into it. To save the completed form from a browser window, choose File > Save As and rename the file. Note: If you do not rename the file it WILL NOT save the information you enter.

Page-by-page Guide to Colorado’s
Advance Health Care Directive

These pages provide tips and instruction for each page.

Colorado eAdvance Health Care Directive cover

Advance Health Care Directive

At this time, we only accept the Advance Health Care Directive on paper.

You can download and print form to fill out with a pen, or save it to your computer and type into it.

Download the Colorado Advance Health Care Directive now.

Share your Advance Health Care Directive with KP:

Colorado eAdvance Health Care Directive page 1

Introduction – Page 1

1-ALearn more about our approach to Life Care Planning

1-BPlease remember to write these items on every page:

  • Your name.
  • Your medical record number, which is found on your blue Kaiser insurance card.

Colorado eAdvance Health Care Directive page 2

Part 1 – My Health Care Agent – Page 2

2-AWhat are the qualities you should look for in agent? Learn how to choose an agent.

2-BLearn more about what is an agent and their responsibilities

2-CSome people don’t have anyone in mind to be their agent. Learn about Life Care Planning without an agent.

Colorado eAdvance Health Care Directive page 3

Part 1 – My Health Care Agent – Page 3

3-AAn alternate agent would be needed if your primary agent is not available. Learn more about agents

3-BVideo: What I might consider when choosing my agent

Colorado eAdvance Health Care Directive page 4

Part 1 – My Health Care Agent – Page 4

4-AThis space may be used for any instructions related to agents and their powers. If you have a family member who has beliefs about these topics that are significantly different from yours, you may decide to exclude this person from being involved in decision-making, even informally.

4-BLearn more about these situations.

Colorado eAdvance Health Care Directive page 5

Part 2 – My Values – Page 5

5-AIn a serious medical situation, where the outcome is uncertain, your agent may look to this section for guidance. You’ll be doing your agent a favor by providing rich detail here.

5-BFor further guidance, read your values are at the center of your life care plan.

5-CSituations where values matter.

5-DIf you are part of a faith community, please add in details of how we may contact them.

Colorado eAdvance Health Care Directive page 6

Part 3 – My Health Care Instructions – Page 6

6-AShould you ever be in a similar situation, it would be valuable for your agent to know your opinion about it.

6-BVideo: Get more details about this brain injury scenario.

6-CVideo: Learn more accepting life sustaining treatments for a specific time period, in this scenario.

Colorado eAdvance Health Care Directive page 7

Part 3 – My Health Care Instructions – Page 7

7-ACPR can save lives, but it’s not as effective most people think. Read a discussion about CPR.

Colorado eAdvance Health Care Directive page 8

Part 4 – My Hopes and Wishes – Page 8

8-ASometimes, our values inform not only what we want, but of what we don’t want. If you have some thoughts about how you would ideally like to die, please add them here.

8-BIf you wish to donate organs or tissues be sure your agent and family are aware of this. For more information about organ and tissue donation please visit DonorAlliance.org

Colorado eAdvance Health Care Directive page 9

Part 5 – Completing this document – Page 9

9-ALearn more about making this document legally valid.

9-BIf you are using Witnesses and/or Notary you’ll want to wait to sign in their presence.

Colorado eAdvance Health Care Directive page 10

Part 5 – Completing this document – Page 10

10-ALearn more about making this document legally valid.

Colorado eAdvance Health Care Directive page 11

Part 5 – Completing this document – Page 11

11-ALearn more about
making this document legally valid.

11-B If you are using a Notary Public you’ll want to sign in their presence.

Colorado eAdvance Health Care Directive page 12

Part 5 – Completing this document – Page 12

12-ARemember if you are using Witnesses and/or Notary you’ll want to wait to sign in their presence.

Colorado eAdvance Health Care Directive page 13

Part 6 – Next Steps – page 13

13-ALearn more about sharing your values with your agent.

13-BIf you have a scheduled doctor appointment, you may hand deliver a copy to your doctor. Alternately you can mail to your local Kaiser Permanente Medical Office (attention to your doctor). Click here for more information on where to mail it to.

13-CRead more: With whom should you share your Life Care Plan?