For Patients


At Queen of Valley Medical Center, we support an individual’s right to choose the care they want. Our Ethical Directives of Catholic Healthcare call on us to respect the dignity of each person.

Advance Care Planning (ACP) encourages patients and families to talk about and document their care preferences in advance to ensure that the care they receive is aligned with their goals, values, and priorities. We have provided resources for you and your family to help you have the conversation and document your wishes in writing.

You can download a California Advance Directive in English as well as several other languages. In addition, there is a link to provide you with Advance Directives for other States. If you or your loved one is seriously ill you may want to consider completing a POLST (Physician Order for Life Sustaining Treatment) with your physician. Having these conversations with your family, loved ones and physician are so important. Take a look at the Advance Directive Tool Kit below to see what tools are available to help you have the conversation. We know that participating in advance care planning improves end-of-life care for both the patient and their family. Let's start talking!

Advance Directive Tool Kit

This tool kit inclues 16 tools to assist families in having the conversation, selecting a healthcare decision maker and completing and Advance Directive. Click here to view the Advance Directive Tool Kit.

Advance Directive Forms

California Advance Health Care Directive Forms

Additional Resources

The Gift of Life

The Gift of Life

The gift of organ and tissue donation can truly be the gift of life. In the event of your death, your family will be asked about your wishes regarding organ or tissue donation. All families of potential donors will be made aware of their option to donate organs or tissues for transplantation in a supportive and comforting manner. If you would like to be a donor upon your death, please inform your family of your decision. Age or history of disease does not necessarily prevent donation.

For more information regarding organ or tissue donation, please call:

Transplant Clinic

(707) 525-5297


United Network of Organ Sharing

(800) 24-DONOR

Five Wishes

Five Wishes serves as an Advance Directive and is a legally-valid tool available for your use. Five Wishes helps ensure your wishes, and those of your loved ones, will be respected-even if you cannot speak for yourself.

POLST (Physician Order for Life Sustaining Treatment)

A new law effective 1/1/16 allows Nurse Practitioners and Physician Assistants to sign the California POLST form. The form is now available in ENGLISH and will be available in other languages later in January 2016. For more information visit

Click here for more information and to download a copy of the POLST in English, Spanish, Chinese, Vietnamese, Korean, Farsi, Armenian, Russian, Tagalog and Hmong.


Click here to download a 2016 California POLST form in English.

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