Advance care plan california template 2026

1. Click ‘Get Form’ to open the advance care plan california template in the editor.
2. Begin by entering the resident's name at the top of the form. This personalizes the document and ensures it is specific to the individual.
3. Indicate whether this discussion is for creating a new Advance Care Plan or reviewing an existing one by checking the appropriate box.
4. Select the reason for this discussion from options such as Admission, Readmission, Change in condition alert, Resident or Family Request, or Other.
5. Identify who participated in this discussion by checking either 'Resident' or 'Resident’s surrogate' and provide their name.
6. Document whether an Advance Care Plan was created or changed as a result of this discussion by selecting one of the provided options.
7. In the designated area, describe key aspects of the discussion to capture important details and decisions made.
8. Check any applicable Advance Directive Orders in Place, ensuring compliance with state requirements.
9. Indicate if the resident is on a Comfort Care/Palliative Care Plan or Hospice by checking the relevant boxes.
10. Finally, have the staff member leading the discussion fill in their name, title, and sign along with dating the document.

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