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Hawaii Advance Health Care Directive | POA & Living Will

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The Hawaii Advance Health Care Directive grants a responsible friend or relative (pursuant to Chapter 327 E-3) the authority to make medical decisions on behalf of the issuing party in the event he or she does not have the mental or physical capacity to do so. Many would consider this type of paperwork imperative to one’s well being should he or she be rendered unable to effectively make decisions or even communicate during a medical event that involves unconsciousness, delirium, or incapacitation.

Definition – § 327E-2

Laws – Chapter 327E (Uniform Health Care Decisions)

How to Write

1 – Obtain the Advance Health Care Directive Form

Once the Principal has settled upon a Health Care Agent, this form may be filled out. Simply click on the form button beneath the image to open the form, then you may save it or work on it directly onscreen. It is recommended to save all work as you progress.

2 – Clearly Identify the Health Care Agent and Alternate Health Care Agent

Read the introduction of this form. When ready, enter the Full Name of the Health Care Agent the Principal wishes to designate, just above the words “Name of Agent.” Then, define the Relationship the Principal and Agent have just above the words “Relationship.”

The second line will be subdivided into several areas “Street Address,” “City,” “State,” and “Zip” where the Health Care Agent’s Residential Address should be accurately reported.

The third blank line will also be divided into a few areas “Home Phone,” “Work Phone,” and “E-Mail.” Make sure to report these items so the Health Care Agent may be reached quickly when necessary.

Now, find the statement “If my agent is not available…” This area will allow the Principal to name an individual as his or her Alternate Agent. This entity may be thought of as a Back-up to the Primary Health Care Agent in case the Primary Agent cannot or will not wield this authority when needed. If the Principal has decided to designate such an Agent, then utilize the next three lines to report the Alternate Agent’s Name, Address, Telephone Numbers, and E-Mail Address.

3 – Officially Grant The Health Care Agent’s With Decision Making Powers

Now that all Health Care Agents have been Identified and their Contact Information reported, it is time to provide a guideline as to what the Principal will allow the Health Care Agent to decide upon.

The Principal may designate the Health Care Agent(s) with the authority to either make all of his or her Health-Care Decisions or withhold some areas from the Health Care Agent’s control. If the Principal wishes the Health Care Agent to make all Health Care Decisions, he or she must place a mark on the first statement in the next area.

If the Principal wishes to withhold some areas or place conditions on the Health Care Agent’s power then he or she must mark the second statement, then specifically define the limitations, restrictions, or conditions to be applied on the blank line after the word “except.”

Next, the Principal should indicate precisely when the Health Care Agent’s Powers should be considered effective. If this Authority goes into effect only upon the Principal’s Primary Physician determines the Principal cannot make his or her own Health Care Decisions, the Principal should mark the line preceding the words “My agent’s authority becomes effective…”

If the Principal wishes for the Health Care Agent’s Decision Making Power to go into effect immediately, then he or she should make a mark on the blank line preceding the words “My agent’s authority to make…”

4 – The Principal Granting Signature

This area will provide the effective signature of the Principal. This item must be validated by either Witnesses or a Notary Public.

The Principal should Print and Sign his or her Name on the blank spaces following the bold words “Your Name.” After signing this document, the Principal must enter the Date he or she signed these lines.

If this form will be validated by Witnesses, then “Option 1: Witnesses” must be tended to by the Witnesses. There will be two sections, one for each Witness. Each Witness must Print his or her Name, Sign his or her Name, the Signature Date, and his or her Address.

If this Signing will be notarized, then “Option 2: Notary Public” will need to be tended to. The Notary Public will fill in the information defining the Principal Signing, then verify its occurrence through the Notarization Process.


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