A California advance health care directive needs either a notary or two qualified witnesses. You need one, not both. In a hospital or care home the witness rules rule out almost everyone in the building, so the notary route is usually simpler. It costs $10 for each document notarized.

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What the document doesLink to this section

An advance health care directive covers two things at once:

It names a health care agent — the person who makes medical decisions for you if you cannot speak for yourself.
It states your wishes about treatment, life support, pain management and organ donation.

Older names for parts of this are "living will" and "health care power of attorney." California folded both into one document under the Health Care Decisions Law.

This is separate from your financial power of attorney. Different document, different agent if you want, different rules.

Notary or witnesses — you pick oneLink to this section

Probate Code § 4673 gives you two ways to execute a directive. You need one of them, not both:

Acknowledged before a notary public, or
Signed by two qualified witnesses.

It is one or the other, not both. If you notarize it, you do not need witnesses at all.

One exception: an electronic advance directive must be notarized. The witness option is not available for it.

Why the notary route is usually simplerLink to this section

The witness route has a lot of disqualifications. Under Probate Code § 4674, a witness cannot be:

Your health care provider, or an employee of your health care provider
The operator or an employee of a community care facility
The operator or an employee of a residential care facility for the elderly
The agent you named in the directive

And at least one of the two witnesses must not be related to you by blood, marriage or adoption, and must not be someone who would inherit from your estate.

In a hospital or a care home, that list rules out nearly everyone in the building. A notary sidesteps the whole problem with one signature.

The special rule for skilled nursing facilitiesLink to this section

If you are a patient in a skilled nursing facility, California adds a requirement on top of whichever method you use: a patient advocate or ombudsman must also sign the directive as a witness.

Probate Code § 4675 requires it, and a notarization does not replace it — the advocate signs either as one of the two witnesses or on top of the notarization. If you are signing in a nursing facility, arrange for the ombudsman before the appointment. The California Department of Aging's Long-Term Care Ombudsman program is the place to start.

The notary processLink to this section

You must be present and aware. The notary has to be satisfied you know what you are signing and are not being pressured.
ID check under Civil Code § 1185. If you are hospitalized without a wallet, two credible witnesses who know you can identify you under oath instead.
Journal entry under Government Code § 8206. No thumbprint is required for a health care directive — that rule applies to deeds, real property documents and financial powers of attorney.
You sign, and the notary completes the Civil Code § 1189 acknowledgment certificate.
Your agent does not sign and does not need to attend.

After it is signedLink to this section

A directive in a drawer helps no one. Give copies to:

Your primary doctor, to put in your medical record
The agent you named, and the alternate
The hospital or facility, if you are admitted

A photocopy of a properly executed directive is valid. You do not need to hand out originals.

Frequently asked questionsLink to this section

Does a California advance health care directive have to be notarized? No. Probate Code § 4673 lets you use a notary or two qualified witnesses. Notarization is one valid option, and it is the easier one in a medical setting.

Can I do both, notary and witnesses? Yes. It is not required, but it is harmless, and some out-of-state institutions are more comfortable seeing both.

Can my daughter witness it if she is my named agent? No. Probate Code § 4674 specifically excludes the named agent from acting as a witness. She also could not serve as the notary.

Can a nurse at the hospital witness it? No, if she is an employee of your health care provider. This is the most common reason a directive gets rejected.

My mother is in a skilled nursing facility. Is a notary enough? No. Under Probate Code § 4675, a patient advocate or ombudsman must also sign as a witness, in addition to the notary or witnesses.

What if the signer cannot hold a pen? California allows signing by mark, and also allows another adult to sign the principal's name in the principal's presence and at their direction. The Notary Public Handbook sets out the procedure for each.

Is a directive from another state valid in California? Generally yes. California recognizes directives validly executed elsewhere. A hospital may still ask you to complete a California form, and whether a specific out-of-state document works is a legal question, not a notary question.

Does the notary keep a copy? No. The notary records the act in a journal but does not keep your document.

General information about notary procedure. A notary public cannot give legal or medical advice, and cannot help you decide what treatment choices to make. Talk to a California attorney and your doctor.

Notarizing an Advance Health Care Directive in California