An advance directive registry is a secure database maintained by a state government or other organization where individuals can store and register their advance directives — including living wills and healthcare powers of attorney — so that healthcare providers can access them quickly when needed. Registering your advance directive with a state registry ensures that your wishes are available to medical professionals in an emergency even if you are unable to communicate and your family cannot locate your physical documents.
Why advance directive registries exist
Advance directives are only effective if healthcare providers know they exist and can access them in a timely manner. In a medical emergency there may not be time to contact family members, locate physical documents, or retrieve records from a physician’s office. An advance directive registry solves this problem by providing a centralized accessible location where healthcare providers can quickly retrieve a patient’s documented wishes.
Without a registry a patient’s advance directive may exist but be unavailable at the critical moment when it is needed most — during an emergency hospitalization, a sudden loss of consciousness, or a rapid decline in condition.
How advance directive registries work
The specific operation of advance directive registries varies by state but generally works as follows:
- The individual creates a valid advance directive according to their state’s legal requirements
- The individual submits the advance directive to the registry — either online, by mail, or in person depending on the state’s system
- The registry assigns a registration number and stores the document securely
- The individual receives confirmation of registration and may receive a wallet card or other identifier showing that they have a registered advance directive
- When a healthcare provider needs to access the directive they search the registry using the patient’s name, date of birth, Social Security number, or registration number
- The registry provides the healthcare provider with the stored directive
Which states have advance directive registries
Advance directive registries are available in many but not all states. States with registries include California, Colorado, Idaho, Louisiana, Montana, Nevada, New York, North Carolina, Oregon, Texas, Utah, Vermont, Virginia, Washington, and others. The availability and features of registries vary significantly by state.
Some states maintain registries operated by the state health department or secretary of state office. Others have registries operated by private nonprofit organizations. In states without a formal registry some hospitals and health systems maintain their own internal registries.
What documents can be registered
Most advance directive registries accept the following types of documents:
- Living wills and advance directives
- Healthcare powers of attorney and healthcare proxy designations
- POLST forms — Physician Orders for Life-Sustaining Treatment — in states where POLST registries are available
- DNR orders — Do Not Resuscitate orders — in some states
The specific documents accepted vary by registry. Some registries accept only state-specific forms while others accept any valid advance directive document.
How to register your advance directive
The process for registering an advance directive varies by state but generally involves:
- Completing a valid advance directive according to your state’s legal requirements including proper signatures and witnesses
- Locating your state’s advance directive registry — your state health department website, your physician, or a hospital social worker can provide information about the registry in your state
- Submitting your advance directive to the registry — this may involve completing an online registration form, mailing a copy of your document, or visiting a registration location in person
- Paying any applicable registration fee — many state registries are free but some charge a small fee
- Receiving confirmation of your registration and any identification card or wallet card provided by the registry
- Updating your registration if you revoke or change your advance directive
Limitations of advance directive registries
While advance directive registries are a valuable tool they have some important limitations:
- Not all states have registries — in states without a formal registry you must rely on other methods to ensure your advance directive is accessible
- Healthcare providers must check the registry — a registry is only useful if providers know to check it. Not all providers are familiar with or routinely check state registries.
- Registries may not be accessible in all emergencies — in some emergency situations — such as when a patient is brought to a facility in another state — the local registry may not be accessible
- Documents must be kept current — a registered advance directive that has been revoked or superseded but not updated in the registry could cause confusion
Alternatives and supplements to registry registration
Because registries have limitations registration should be combined with other steps to ensure your advance directive is accessible:
- Give copies to your healthcare agent, primary care physician, and any specialists
- Provide a copy to any hospital, nursing home, or other facility where you receive care
- Keep a copy at home in an easily accessible location — not in a safe deposit box
- Carry a wallet card indicating that you have an advance directive and where it can be found
- Make sure family members and your healthcare agent know where your documents are kept
- Consider storing a digital copy in a personal health record or with a secure document storage service
National resources for advance directive information
Several national organizations provide information about advance directives and registries:
- CaringInfo — a program of the National Hospice and Palliative Care Organization at caringinfo.org provides free state-specific advance directive forms and information about registries in each state
- National POLST — polst.org provides information about POLST forms and registries by state
- American Bar Association — provides resources on advance directives and healthcare decision making
- Your state health department — the primary source of information about your state’s advance directive registry
Key terms to know
- Advance directive registry — a secure database where individuals can store advance directives for access by healthcare providers
- Advance directive — a legal document describing a person’s wishes regarding medical treatment and naming a healthcare decision maker
- Living will — a document describing specific medical treatment wishes
- Healthcare power of attorney — a document naming a person to make medical decisions on behalf of another
- POLST — Physician Orders for Life-Sustaining Treatment, a medical order form addressing life-sustaining treatment preferences
- DNR order — Do Not Resuscitate order, a medical order instructing providers not to perform CPR
- Healthcare agent — the person named to make medical decisions under a healthcare power of attorney
- CaringInfo — a program of the National Hospice and Palliative Care Organization providing free advance directive resources
Sources
- CaringInfo — National Hospice and Palliative Care Organization — caringinfo.org
- National POLST — polst.org
- American Bar Association — Public Resources
- National Institute on Aging — Advance Care Planning
This article is for general informational purposes only and does not constitute legal or medical advice. Advance directive registry availability and procedures vary by state. Consult a licensed attorney or healthcare provider for guidance specific to your situation.