How to Upload Your Advance Directive to Kaiser Permanente and Sutter Health

You signed your advance directive, had it properly witnessed, and feel accomplished. But here's the gap most people miss: paramedics and ER doctors don't check the Secretary of State registry or call your family during a code. They pull up your electronic health record. If your directive isn't in that system, it functionally doesn't exist during the first critical hours of an emergency.

For the millions of Californians covered by Kaiser Permanente or Sutter Health, uploading your executed directive to their portal is the single most important distribution step.

Kaiser Permanente: Upload Process

Kaiser operates strict, centralized workflows for directive intake. Here's the exact process:

Online upload (preferred):

1. Log in to kp.org
2. Navigate to "Medical Records" or search for "Life Care Planning"
3. Select "Advance Health Care Directive" upload
4. Upload your document as a single PDF file

File requirements:

• PDF format only
• Under 4MB file size
• Every page must contain your full legal name and Medical Record Number (MRN) at the top
• Document must be clearly legible (no dark shadows, cut-off edges, or blurry text)

Alternative submission methods:

• Email to [email protected] (Southern California)
• Mail a hard copy to the Northern California Health Education Department (2241 Geary Blvd, San Francisco, CA 94115 for the SF region)

Processing time: 7 business days. Kaiser's central scanning department manually reviews, indexes, and enters documents into the Epic clinical platform. Until processing is complete, emergency room staff cannot see your directive in the system.

Common rejection reasons:

• Missing MRN on pages
• File exceeds 4MB
• Document is unreadable (poor scan quality)
• Name on document doesn't exactly match the name in Kaiser's system

If rejected, Kaiser sends a notification through the portal message center. Fix the issue and resubmit.

Sutter Health: Upload Process

Sutter's My Health Online (MHO) portal handles directive submissions:

1. Log in to My Health Online (sutterhealth.org)
2. Navigate to medical records or advance care planning
3. Upload your executed directive as a PDF

Sutter also accepts:

• Faxed copies to your primary care office
• Physical copies delivered to your provider's front desk

Processing time: Similar to Kaiser — up to 7 business days for administrative indexing before the document appears in your electronic health record.

Sutter's system emphasizes treating the directive as a living document — they recommend updating it whenever you experience a major change in health status.

Why Portal Upload Matters More Than Registration

The California Secretary of State registry (Form SFL-461, $10 fee) creates a searchable record that your directive exists. But it doesn't give doctors instant access to the document itself — someone still has to contact the registry, get the location information, and retrieve the physical copy.

Your hospital portal upload puts the actual document inside the system that ER doctors, hospitalists, and palliative care teams access in real time. When you're admitted unconscious:

• Registry: someone eventually finds out a directive exists somewhere
• Portal: the attending physician sees your wishes immediately in your chart

Both are valuable, but the portal upload provides immediate clinical access during the window where decisions are being made.

Tips for a Clean Upload

Scan quality: Use a flatbed scanner at 300 DPI, not a phone camera. Phone photos create shadows, skewed angles, and unreadable text that triggers rejection.

File organization: Scan all pages into a single PDF (not multiple separate images). Include the signature page, witness attestations, and any addenda (dementia addendum, HIPAA authorization).

Name matching: The name on your directive must exactly match your name in the hospital system. If you go by a middle name, nickname, or hyphenated name — check what's in the portal first and ensure your directive matches.

Multiple systems: If you see doctors at both Kaiser and Sutter (or any other California system), upload to each. They don't share records automatically.

After Upload: Verify It Took

Don't assume the upload worked. After the 7-business-day processing window:

1. Log back into the portal
2. Check your medical records for the uploaded directive
3. Verify all pages are visible and readable
4. If it's not there, contact medical records directly

Some patients also ask their primary care physician to confirm the directive is visible in the chart during their next appointment.

The Complete Upload and Distribution System

The California Advance Directive & Living Will Kit includes Kaiser and Sutter upload checklists with exact formatting requirements, scan quality guidelines, and the broader distribution workflow — ensuring your directive is accessible to every provider who might need it, not just filed away in a drawer.

See more California guides →