Guide to Advance Care Planning Documents

What Is Advance Care Planning?

Advance care planning allows you to have a voice in your health care.

It allows you to:

• Name a trusted person to make medical decisions if you are unable to do so.
• Let this trusted person and your doctors know what is most important to you in life and your health care.
• Record the name of your trusted person and your medical wishes in an advance directive (AD) form.

At UCSF, we encourage all our adult patients, at any age or stage of health, to talk to their provider about their wishes for medical care and to fill out an AD.

To enter your care preferences into your medical record, you can:

• Discuss your wishes for care with a member of your health care team
• Give a copy of your advance care planning (ACP) document to a member of your care team who can scan it into your medical record
• Upload your ACP document through the Advance Care Planning page in MyChart (instructions below)

What Is an Advance Care Planning Document?

The most common advance care planning document is an advance directive (AD). Other documents include a living will, health care power of attorney and physician order for life-sustaining treatment (POLST).

• Advance directive. Records your medical wishes and names a person to make medical decisions on your behalf, if you are unable to do so.
• Living will. Records only your medical wishes.
• Health care power of attorney. Records only the person trusted to make medical decisions on your behalf.
• POLST is a physician order. It is filled out by a doctor. It is focused only on your wishes regarding cardiopulmonary resuscitation (CPR) and care in an emergency. This document informs emergency personnel about your medical preferences.

Having an advance care planning document means your medical team and your loved ones will understand your wishes, even if you are unable to speak for yourself.

Where to obtain an AD form:

• Advance Care Planning page in MyChart 
• The front desk when you check in for a medical appointment
• Patient and Family Cancer Support Center at the Bakar Precision Cancer Medicine Building, 1825 Fourth Street, in the main lobby
• UCSF MERI Center webpage or the PREPARE webpage

To get help filling out an AD form:

• Sign up for UCSF's monthly free online Advance Care Planning Workshop, which guides you through the steps of filling out an AD. To register, go to the MERI Center webpage.
• Ask to speak to a social worker who can help you fill out the form.

How to Upload Your ACP Document Into MyChart

A member of your care team can help you get your ACP document into your medical record.

If you would like to upload your forms yourself, you will need to:

1. Scan and upload your ACP document onto your personal computer or mobile device. Make sure to scan and upload all pages. (If you don't know how to scan and upload a document, bring your ACP form with you to your next visit and give it to a member of your care team.)
2. Locate the Advance Care Planning section in MyChart.
   1. Click on the menu button in the upper left corner of your MyChart account. A search box will appear with a drop-down menu of options.
   2. Type "advance care planning" into the search box or scroll down to the "Advance Care Planning" option, which is under the "My Record" section.
   3. Once you are on the Advance Care Planning page, click on "Add an image or document" to upload your ACP form.
3. Select the ACP document that you saved on your computer or personal device and upload it to this section. This will add the form to your medical record.

Before you upload your document, make sure to:

• Sign and date it
• Get additional necessary signatures (see requirements below)

UCSF accepts the following documents:

• Advance directive (AD)
• Living will
• Durable power of attorney for health care
• Physician orders for life-sustaining treatment (POLST)
• Other ACP documents

File upload requirements:

• Allowed file formats are JPG, PDF, PNG and TIFF.
• The maximum size accepted is 10 MB.
• All pages must be uploaded as a single document.
• For an AD, the document must be dated and signed by you as well as by either two witnesses or a notary public. See below.

What happens once you upload your document?

• Your document will be reviewed by UCSF Health staff within five business days.
• If it is complete, it will show up on your Advance Care Planning page in MyChart. Your medical team will also be able to access it.
• If it is not complete, it will show up on your Advance Care Planning page as "Not Accepted" with information about what is needed.
• If you have questions, contact [email protected].

Advance Directive Signature Requirements

An AD must be signed by two people (also referred to as witnesses) or by a notary public. Please review the information below for more information.

The two people (witnesses) who sign your AD:

• Must be over the age of 18
• May not be the person you designate as your medical decision-maker
• May not be your health care provider or anyone on your health care team
• May not be an operator or employee of a community care facility or a residential care facility in which you reside

One of the signatures must be from someone who:

• Is not related to you by blood, marriage or adoption
• Will not benefit financially (inherit property or money from you) when you die

What is a notary public?

You need a notary only if you do not have two witnesses who can sign the form.

A notary public is a person whose role is to confirm that a signature is valid, meaning that it is signed freely (not under duress), and to verify the identity of the person signing. Notary services generally cost $15 or more to have a mobile notary come to you.

You can find a list of notary services in your area by searching online. Many mail delivery businesses (such as UPS and FedEx stores), libraries, banks, photocopy shops, tax businesses and hospitals offer notary services.

The UCSF Patient and Family Cancer Support Center provides free notary services by appointment to UCSF patients receiving cancer care. Call (415) 885-3693 or email [email protected] to schedule. The UCSF MERI Center for Education in Palliative Care maintains a list of notary services close to the UCSF campuses in San Francisco.

By uploading this form (AD, living will, durable power of attorney or POLST), you confirm that:

1. The information provided is true and correct.
2. The document is in compliance with California or federal laws.**
3. The form, if executed in another state, is in compliance with the laws of that state or the laws of California

 

**California laws include Probate Code Sections 4673, 4674, 4675 and 4680, and federal laws include 10 U.S.C. Section 1044.