Hawaii Advance Directive Form — How to Complete Your AHCD Under HRS 327E

What a Hawaii Advance Health Care Directive Actually Does

Hawaii's Advance Health Care Directive — authorized under HRS Chapter 327E — combines two legal instruments into a single document. It names a health care agent who can make medical decisions when you cannot, and it records your personal wishes about end-of-life treatment, comfort care, and organ donation.

This is different from a financial power of attorney, which covers bank accounts and property. The AHCD deals exclusively with medical authority. If your parent is hospitalized and can't speak for themselves, the person named in this document is the one hospitals call.

The Hawaii Department of Health publishes a free statutory form. Kokua Mau, the statewide end-of-life coalition, distributes the same form with a plain-language FAQ sheet that walks families through each section. Either version satisfies HRS 327E.

The Execution Rules That Trip People Up

Hawaii gives you two paths to make the directive legally valid. You need the principal's signature plus one of these:

Option A — Two qualified witnesses. Both must be adults. Neither witness can be the designated health care agent. Neither can be a health care provider or an employee of a health care provider or facility. And at least one witness must be unrelated to the principal by blood, marriage, or adoption, and must have no claim on the principal's estate.

Option B — Notary acknowledgment. A notary public can authenticate the signature instead of two witnesses. This is often simpler for families who can arrange a notary, since it avoids the witness restrictions.

You only need one path — witnesses or notary, not both. But getting the witness restrictions wrong is the most common reason hospitals flag a directive as potentially invalid. If a nurse at the care facility signs as a witness, the directive may not satisfy the execution requirements.

Advance Directive vs. Living Will — Hawaii Treats Them as One

In many mainland states, a living will and a health care power of attorney are separate documents. Hawaii's statutory AHCD combines these functions. The AHCD form under HRS 327E contains sections for both: Part 1 names your agent, and Part 2 records your treatment preferences.

If someone searches for a "Hawaii living will form," the AHCD is the statutory form that combines treatment instructions with a health care agent. A separate written or oral treatment instruction can also express your wishes, but without naming an agent it leaves no named decision-maker to interpret your wishes when a situation falls outside what you explicitly wrote down.

How the AHCD Connects to POLST and DNR Orders

An advance directive is a planning document you complete while you still have capacity. A Provider Order for Life-Sustaining Treatment (POLST) is a medical order — printed on bright pink paper in Hawaii — that a physician or APRN signs based on a patient's current condition. The POLST governs emergency interventions like CPR, intubation, and artificial nutrition.

The two documents work together but serve different moments. The AHCD kicks in when a patient loses decision-making capacity. The POLST travels with the patient and tells paramedics what to do right now. If your parent has advanced illness or frailty, you likely need both.

A Do Not Resuscitate order is narrower still — it covers only CPR in cardiac or respiratory arrest.

What Happens Without an Advance Directive

If your parent loses capacity without having signed an AHCD, Hawaii's surrogate decision-making law takes over. Under HRS 327E-5, a physician documents the patient's incapacity, then selects a surrogate from a statutory hierarchy: spouse or reciprocal beneficiary first, then adult children, then parents, then siblings.

This fallback works for immediate medical decisions, but it can create friction. The supervising health-care provider must require a written declaration establishing the surrogate's claimed authority, but the surrogate may not have a single planning document to show other administrators. Hospitals and nursing facilities may hesitate, especially with family disagreements. And surrogate authority doesn't give general authority over financial matters or real estate — you'd need a separate financial POA, program-specific authorization, or court-ordered conservatorship for those tasks.

Getting the AHCD done while your parent can still sign eliminates this entire chain of problems.

Completing the Form Step by Step

Section 1 — Appointment of agent. Name a primary health care agent and at least one alternate. The agent's authority activates when the primary physician determines the principal lacks capacity, unless the form specifies immediate authority.

Section 2 — Treatment instructions. The form offers checkboxes for life-sustaining treatment, artificial nutrition and hydration, and comfort care preferences. Customize these — generic "no heroic measures" language doesn't give physicians enough guidance.

Section 3 — Signature and authentication. The principal signs and dates the form, then completes either the witness block or notary block as described above.

After signing: Give copies to the named agent, the principal's primary care physician, and any care facility. Hawaii does not require filing with a court or government office. The original stays with the principal.

Where to Get the Form

The Hawaii Department of Health publishes the official AHCD form as a free PDF. Kokua Mau (kokuamau.org) offers the same form bundled with explanatory materials and links to community workshops across the islands.

If your family also needs to handle financial authority, guardianship preparation, or Med-QUEST applications, the Hawaii Power of Attorney & Guardianship Kit packages the AHCD alongside the financial POA, court-filing guides, and a capacity-assessment worksheet — so you can address medical and financial authority in one coordinated pass rather than piecing together separate downloads.

Frequently Asked Questions

Does my Hawaii advance directive work on the mainland? Most states honor out-of-state directives under their own laws, but enforcement isn't guaranteed. If your parent splits time between Hawaii and another state, consider executing a directive that meets both states' requirements.

Can I revoke or change an advance directive? Yes. Under HRS 327E-4, a principal with capacity can revoke an agent designation by signed writing or by personally informing the supervising health-care provider; other parts of the directive can be revoked in any manner that communicates an intent to revoke.

Do I need a lawyer to complete the form? No. The statutory form is designed for consumer use without legal counsel. Where families typically benefit from an attorney is complex situations — multiple agents who disagree, or a parent with fluctuating capacity.

See more Hawaii guides →