Information about the Hawai‘i Advance Health Care Directive
An Advance Directive (AD) is a written statement about your future medical care. It is a gift to family members and friends so that they won’t have to guess what you want if you no longer can speak for yourself. The Hawaii Advance Directive with the header “Hawai‘i Advance Health Care Directive“ was last updated in December of 2015.
Click here to download the free 3-page Advance Directive (6 pages Pdf file, 2-sided plus one & information: Your Advance Directive for Future Healthcare.) Developed by Kōkua Mau and the Executive Office on Aging, this form was updated in December 2015. Please make sure you read the background information attached to the PDF file or on this page, before you fill it out.
A writable or fillable PDF file of the Advance Directive form now available to download.
In this writable version PDF file (after you downloaded the PDF into your computer) making it easier to read since you can type your answers. You have to download this file into your computer, fill it out in your computer and print and sign it. We do not offer any forms that can be filled out or filed on-line. (Please note: some fields need to be initialed or signed by you or your witnesses and are not fillable in a computer.)
Companion Booklet: Your Advance Directive for Future Healthcare explained: A two page check list to help complete an Advance Directive, explaining the terms used and answering questions.
3-page Hawaii Advance Directive only (no info sheet attached)
Multilingual Advance Directives in 10 languages (since May 2016)
The Conversation Project Starter Kit is available in a few languages. Kōkua Mau offers a writable/fillable PDF file of the Starter Kit (in English). The Starter Kit will help you or your organization to get your thoughts together and then have the conversation. Note: Before filling in a Starter Kit, save it to your desktop. Otherwise, anything you type in it will not be saved.
While the ‘older’ Advance Directive forms with the word ‘Advance Health Care Directive Form’ are still valid, we recommend that you only use the new form listed above with the header “Hawai‘i Advance Health Care Directive“.
Remember: Everyone needs an Advance Health Care Directive – Not Everyone needs a POLST
- Click here for a chart with the differences between an Advance Directive and a POLST. Download a PDF of the differences.
Why do I need an Advance Directive?
Medical technology makes it possible for patients with little or no hope of recovery to be kept alive for months or even years. This makes it important for you to discuss what kind of care you want before illness occurs.
Now is the time to talk about these important issues, while you can still make your own decisions and have time to talk about them with others. If you don’t have an advance directive, and even one person interested in your care disagrees, your doctor may not honor your wishes for end of life care.
What do I put in my advance directives?
The kind of medical treatment you want or don’t want.
You can say whether or not you want to be kept alive by machines that breathe for you or feed you even if there is no hope you’ll get better.
The person you want to make decisions for you when you cannot.
This person (or agent) does not have to be an attorney. Unless you limit your agent’s authority, your agent has the right to accept or refuse any kind of medical care and testing, discharge or select doctors, and see all medical records.
Your wishes for comfort care.
You can indicate whether you want medicine for pain or where you want to spend your last days. You can also give spiritual, ethical and religious instructions.
How can I ensure that my advance directive is honored?
Share copies and talk with people who will be involved in your care. Ask your doctor to make your advance directive part of your medical records.
Instructions for advance health care directives
Complete parts 1 and 2 on the downloaded Advance Directive form. You may add pages and make any changes you wish. You do not need an attorney to complete this form. If you need more help, you may contact the following resources for assistance.
Contact the Legal Aid Society on all islands by calling 1-888-536-0011
Part 1 – Health Care Power of Attorney
Select one or more persons to be your agent and make health care decisions if you are unable. The person you appoint can be a spouse, adult child, friend or any other trusted person. Your agent cannot be an owner or employee of a health care facility unless they are related to you.
Part 2 – Individual Instruction
Give instructions to your doctor and others about any aspect of your health care. You will be given choices. Check only one box in each category and cross out all which do not apply.
Ask 2 witnesses to sign and date the form
Both must be people you know. They cannot be health care providers (like a doctor, nurse or social worker), employees of a health care facility, or the person you choose as an agent. One of the two persons cannot be related to you or have inheritance rights.
– Or –
If you do not have 2 witnesses, your advance directive must be notarized.
When you have completed your advance directive
- Be sure to have it witnessed or notarized
- Inform your family, friends, and doctors that you have done this
- Give copies of it to your health care agent, doctors, and others who might be involved in your care
- Keep a copy in any easy to find place in your home
- Chinese simplified Hawaii Advance Health Care Directive
- Chinese traditional Hawaii Advance Health Care Directive
- Ilocano Hawaii Advance Health Care Directive
- Japanese Hawaii Advance Health Care Directive
- Korean Hawaii Advance Health Care Directive
- Marshallese Hawaii Advance Health Care Directive
- Spanish Hawaii Advance Health Care
- Tagalog Hawaii Advance Health Care Directive
- Tongan Hawaii Advance Health Care Directive
- Vietnamese Hawaii Advance Health Care Directive
More Kōkua Mau Materials:
- Questions about CPR
- The 16-page Kōkua Mau booklet “A Guide to Advance Care Planning: Making Life Decisions“