Patient Filling out Advance Directive

Complete Your Advance Directive

An advance directive is a legal document that describes the types of medical care you want to receive if you are unable to make medical decisions for yourself.

Your advance directive also tells your medical providers who you have chosen to be your health care agent. Your health care agent is the person you choose to make health care decisions for you if you’re unable to do so for yourself. Your health care agent is a person who will honor your personal health care decisions.

You can change your advance directive anytime.

What Advance Directive form Can You Use?

Cottage Health provides the My Care advance directive to patients and community members. However, patients can also submit other legal advance directives to Cottage Health, and they will be honored.

Download My Care:

Who Do You Give Your Advance Directive to?

It’s important to share your Advance Directive with your medical providers and loved ones. This form needs to be easily accessible in case you have a medical emergency.

  • Once you and your witnesses have signed the document, make a copy and submit to Cottage Health in one of four convenient ways:
    • Mail:
      Advance Care Planning
      Rebecca Simonitsch
      Cottage Health
      P.O. Box 689
      Santa Barbara, CA 93102
    • Email copy to:
    • Fax copy to: 805-569-7854
    • In Person: Completed MyCare forms may be submitted to a concierge desk at any Cottage Health location.
    • Santa Barbara Cottage Hospital
      400 W. Pueblo St.
      Santa Barbara, CA 93105
    • Goleta Valley Cottage Hospital
      351 S. Patterson Ave.
      Goleta, CA 93111
    • Santa Ynez Valley Cottage Hospital
      2050 Viborg Rd.
      Solvang, CA 93463
  • Cottage Health will put your Advance Directive in your medical record so that it is accessible to all Cottage Health providers. Cottage Health will also create a medical record for you if you are not currently a patient.
  • It’s important to also give copies of your Advance Directive to your other medical providers, family, and close friends. You may also want to give a copy to an attorney or your faith community.
  • Be sure to keep copies for yourself at home.

What Types of Decisions Does a Health Care Agent Make for You?

You can indicate on your My Care Advance Directive the types of decisions your health care agent can make. They could include:

  • Choosing your doctors and where you’ll receive care
  • Speaking with your medical providers
  • Deciding about tests, medicine, and surgery you could have
  • Planning for your medical care in California or another state
  • Reviewing and releasing your medical record
  • Planning for care in a nursing home or residential care facility
  • Making arrangements if you die

Who Can Be Your Health Care Agent?

A family member, friend or someone who:

  • Is 18 years or older
  • Knows you well
  • Agrees to accept this responsibility
  • Can be trusted to honor your wishes and values
  • Can make difficult decisions in stressful situations
  • Can be calm and think clearly when talking with your medical providers, family, and friends
  • Can be contacted easily by your medical providers

Who Cannot be Your Health Care Agent?

  • Your doctor
  • Someone who works at the hospital, clinic, or facility where you receive medical care, unless he or she is a family member or registered domestic partner

Can You Have More Than One Health Care Agent?

It’s important you choose one person to be your health care agent. Often, when patients choose more than one health care agent it can be difficult during a medical crisis to reach everyone, for everyone to agree, and for everyone to be calm and think clearly during a difficult situation.

You can choose a second and third health care agent for medical providers to contact in case your first health care agent is unavailable. Be sure to discuss your health care decisions with your second and third health care agents too.