California · Advance health care directive
California advance health care directive signing requirements
Names the person who makes medical decisions when you cannot, and records what you want done — and not done.
Verified against the current statute text on 2026-09-19 by Michael Seutin, California Notary Public, commission 2518648.
Witnesses
Two adult witnesses, or a notary's acknowledgment instead. In a skilled nursing facility, a patient advocate or ombudsman must sign as a witness as well — whichever route is used.
Notary
Not required. A notary's acknowledgment replaces the two witnesses. The one case where a notary is mandatory is an electronic directive.
The statute
Probate Code §4673, §4674 and §4675
Recording
Never recorded. Copies go to the agent, the doctor and the hospital; California also has a registry with the Secretary of State, which is optional.
What California law requires
A written advance health care directive is legally sufficient when it is dated, signed by the patient (or by another adult in the patient's presence and at their direction), and either acknowledged before a notary public or signed by two qualifying witnesses. Probate Code §4673.
The witnesses cannot include the agent being named, the patient's health care provider, or an employee of that provider. At least one witness must be unrelated to the patient by blood, marriage or adoption and not entitled to any part of the estate, and both must declare under penalty of perjury that the patient appears of sound mind and under no duress. Probate Code §4674.
If the patient is in a skilled nursing facility when the directive is signed, it is not effective unless a patient advocate or ombudsman signs it as a witness — either as one of the two witnesses or in addition to notarization. The notary's stamp alone does not make a skilled-nursing directive effective. Probate Code §4675.
An electronic advance directive must be acknowledged before a notary; the two-witness route is not available for it. Probate Code §4673.
From the signings
In a hospital the nurse will not witness and by statute the hospital's own staff cannot, which is why the call for a notary comes from the floor rather than the family. In skilled nursing the surprise is the ombudsman: the stamp alone does not make the directive effective, and the ombudsman's visit is what sets the date of the signing.
At the signing
- 1
Date it, and have the patient sign in the notary's presence or acknowledge the signature.
- 2
The patient must be awake, oriented, and able to say what the document is. That is the notary's judgment at the bedside, not the family's.
- 3
Government photo ID, or a credible witness under oath. Hospital ID bands do not count.
- 4
In a skilled nursing facility, book the ombudsman before booking the notary. Without that signature the directive is not effective, stamp or no stamp.
- 5
Hospital staff cannot witness; the notary route exists for exactly that reason.
Common questions
No. Probate Code §4673 accepts either a notary's acknowledgment or two qualifying witnesses. In a hospital the notary route is usually the only one that works, because staff cannot witness under §4674.
No. Probate Code §4674 bars the patient's health care provider and the provider's employees from witnessing. That is most of the people in a hospital room.
Not by itself. Probate Code §4675 says a directive signed while the patient is in a skilled nursing facility is not effective unless a patient advocate or ombudsman also signs as a witness, even when it is notarized.
Sources
General information about how a document is executed under California law, not advice about your situation. A notary public is not an attorney and cannot choose a document for you or fill one in. The full disclaimer.