4670. An adult having capacity may give an individual health care
instruction. The individual instruction may be oral or written. The
individual instruction may be limited to take effect only if a
specified condition arises.
4671. (a) An adult having capacity may execute a power of attorney
for health care, as provided in Article 2 (commencing with Section
4680). The power of attorney for health care may authorize the agent
to make health care decisions and may also include individual health
(b) The principal in a power of attorney for health care may grant
authority to make decisions relating to the personal care of the
principal, including, but not limited to, determining where the
principal will live, providing meals, hiring household employees,
providing transportation, handling mail, and arranging recreation and
4672. (a) A written advance health care directive may include the
individual's nomination of a conservator of the person or estate or
both, or a guardian of the person or estate or both, for
consideration by the court if protective proceedings for the
individual's person or estate are thereafter commenced.
(b) If the protective proceedings are conservatorship proceedings
in this state, the nomination has the effect provided in Section 1810
and the court shall give effect to the most recent writing executed
in accordance with Section 1810, whether or not the writing is a
written advance health care directive.
4673. (a) A written advance health care directive is legally
sufficient if all of the following requirements are satisfied:
(1) The advance directive contains the date of its execution.
(2) The advance directive is signed either by the patient or in
the patient's name by another adult in the patient's presence and at
the patient's direction.
(3) The advance directive is either acknowledged before a notary
public or signed by at least two witnesses who satisfy the
requirements of Sections 4674 and 4675.
(b) An electronic advance health care directive or power of
attorney for health care is legally sufficient if the requirements in
subdivision (a) are satisfied, except that for the purposes of
paragraph (3) of subdivision (a), an acknowledgment before a notary
public shall be required, and if a digital signature is used, it
meets all of the following requirements:
(1) The digital signature either meets the requirements of Section
16.5 of the Government Code and Chapter 10 (commencing with Section
22000) of Division 7 of Title 2 of the California Code of Regulations
or the digital signature uses an algorithm approved by the National
Institute of Standards and Technology.
(2) The digital signature is unique to the person using it.
(3) The digital signature is capable of verification.
(4) The digital signature is under the sole control of the person
(5) The digital signature is linked to data in such a manner that
if the data are changed, the digital signature is invalidated.
(6) The digital signature persists with the document and not by
association in separate files.
(7) The digital signature is bound to a digital certificate.
4674. If the written advance health care directive is signed by
witnesses, as provided in Section 4673, the following requirements
shall be satisfied:
(a) The witnesses shall be adults.
(b) Each witness signing the advance directive shall witness
either the signing of the advance directive by the patient or the
patient's acknowledgment of the signature or the advance directive.
(c) None of the following persons may act as a witness:
(1) The patient's health care provider or an employee of the
patient's health care provider.
(2) The operator or an employee of a community care facility.
(3) The operator or an employee of a residential care facility for
(4) The agent, where the advance directive is a power of attorney
for health care.
(d) Each witness shall make the following declaration in
"I declare under penalty of perjury under the laws of California
(1) that the individual who signed or acknowledged this advance
health care directive is personally known to me, or that the
individual's identity was proven to me by convincing evidence, (2)
that the individual signed or acknowledged this advance directive in
my presence, (3) that the individual appears to be of sound mind and
under no duress, fraud, or undue influence, (4) that I am not a
person appointed as agent by this advance directive, and (5) that I
am not the individual's health care provider, an employee of the
individual's health care provider, the operator of a community care
facility, an employee of an operator of a community care facility,
the operator of a residential care facility for the elderly, nor an
employee of an operator of a residential care facility for the
(e) At least one of the witnesses shall be an individual who is
neither related to the patient by blood, marriage, or adoption, nor
entitled to any portion of the patient's estate upon the patient's
death under a will existing when the advance directive is executed or
by operation of law then existing.
(f) The witness satisfying the requirement of subdivision (e)
shall also sign the following declaration in substance:
"I further declare under penalty of perjury under the laws of
California that I am not related to the individual executing this
advance health care directive by blood, marriage, or adoption, and,
to the best of my knowledge, I am not entitled to any part of the
individual's estate upon his or her death under a will now existing
or by operation of law."
(g) The provisions of this section applicable to witnesses do not
apply to a notary public before whom an advance health care directive
4675. (a) If an individual is a patient in a skilled nursing
facility when a written advance health care directive is executed,
the advance directive is not effective unless a patient advocate or
ombudsman, as may be designated by the Department of Aging for this
purpose pursuant to any other applicable provision of law, signs the
advance directive as a witness, either as one of two witnesses or in
addition to notarization. The patient advocate or ombudsman shall
declare that he or she is serving as a witness as required by this
subdivision. It is the intent of this subdivision to recognize that
some patients in skilled nursing facilities are insulated from a
voluntary decisionmaking role, by virtue of the custodial nature of
their care, so as to require special assurance that they are capable
of willfully and voluntarily executing an advance directive.
(b) A witness who is a patient advocate or ombudsman may rely on
the representations of the administrators or staff of the skilled
nursing facility, or of family members, as convincing evidence of the
identity of the patient if the patient advocate or ombudsman
believes that the representations provide a reasonable basis for
determining the identity of the patient.
4676. (a) A written advance health care directive or similar
instrument executed in another state or jurisdiction in compliance
with the laws of that state or jurisdiction or of this state, is
valid and enforceable in this state to the same extent as a written
advance directive validly executed in this state.
(b) In the absence of knowledge to the contrary, a physician or
other health care provider may presume that a written advance health
care directive or similar instrument, whether executed in another
state or jurisdiction or in this state, is valid.
4677. A health care provider, health care service plan, health care
institution, disability insurer, self-insured employee welfare plan,
or nonprofit hospital plan or a similar insurance plan may not
require or prohibit the execution or revocation of an advance health
care directive as a condition for providing health care, admission to
a facility, or furnishing insurance.
4678. Unless otherwise specified in an advance health care
directive, a person then authorized to make health care decisions for
a patient has the same rights as the patient to request, receive,
examine, copy, and consent to the disclosure of medical or any other
health care information.