California Advance Directive

Information you will need

• Principal Name
• Agent Name
• Agent Address
• Agent Home Telephone Number
• Agent Work Phone Number
• Agent City
• Agent State
• Agent ZIP Code
• First Alternate Agent Name
• First Alternate Agent State
• First Alternate Agent ZIP Code
• First Alternate Agent Address
• First Alternate Agent City
• First Alternate Agent Home Phone Number
• First Alternate Agent Work Phone Number
• Second Alternate Agent Name
• Second Alternate Agent Home Phone Number
• Second Alternate Agent Work Phone Number
• Second Alternate Agent Address
• Second Alternate Agent City
• Second Alternate Agent State
• Second Alternate Agent ZIP Code
• Agent Post Death Authority
• Relief From Pain

…and 37 more fields in the PDF.

Completed by the agent and the provider and the employee.

The form includes 4 signature lines, a notary acknowledgment, a witness section.

The document text refers to the laws of California.