How to Get a Hawaii Advance Directive Into Hospital Records Before Surgery

If you have surgery scheduled in Hawaii — whether elective or urgent — getting a valid advance directive into the hospital's electronic health records before your procedure is the single most important step you can take. The hospital will ask about it during pre-admission. If you already have one on file, the surgical team knows your wishes before you go under anesthesia. If you don't, your family faces the consensus decision-making process under HRS § 327E-5 if anything goes wrong on the table.

Here's the timeline and process for getting it done before your scheduled procedure.

The Pre-Surgery Timeline

Most scheduled surgeries give you 2-4 weeks of lead time between booking and the procedure date. That's more than enough to execute a valid advance directive and get it into hospital records — but only if you know the steps.

Week 1: Complete and execute the directive

1. Fill out your Advance Health-Care Directive (AHCD) — Parts 1 (healthcare agent designation) and 2 (treatment instructions)
2. Screen your witnesses using HRS § 327E-3 disqualification rules — your named agent, treating physician, and care facility employees cannot serve as witnesses
3. Arrange signing: you, two qualifying witnesses (or a notary), all signing with wet ink on the same day
4. Verify: correct county in the notary block, all dates matching, no electronic signatures

Week 2: Submit to the hospital

5. Call the hospital's Health Information Management (HIM) or Medical Records department — not the admissions desk
6. Ask for the current advance directive intake process; facilities may use walk-in drop-offs, faxing, or mailing depending on their policy
7. Request confirmation that the directive has been scanned and flagged in your electronic health record
8. Confirm your pre-admission appointment includes a review of your directive with the surgical team

Before surgery day:

9. Bring a physical copy to pre-admission — even if it's already in the system
10. Confirm your healthcare agent's contact information is in the pre-op records
11. If you have a POLST form, bring that separately — it's a medical order, not part of the AHCD

Hospital-Specific Submission at Hawaii's Major Systems

Each hospital system has its own intake process for advance directives. Knowing which department to contact saves you from being bounced between offices.

Kaiser Permanente Hawaii — Contact Member Services or your primary care clinic to ask how to submit the directive. Request that it be tagged in your chart before the surgical consult.

Hawaii Pacific Health (Straub, Pali Momi, Kapiolani, Wilcox) — Contact the Medical Records department at the specific facility where your surgery is scheduled. Ask whether a copy must be submitted to each facility if you receive care at multiple HPH hospitals.

Queen's Health Systems (Queen's Medical Center, The Queen's Medical Center – West Oahu) — Contact Health Information Management and confirm whether mail, fax, or in-person drop-off is currently accepted.

Neighbor island hospitals (Maui Memorial, Kona Community, Hilo Medical Center) — Contact Medical Records directly and confirm the current processing time; submit promptly before your procedure.

What Happens If You Don't Have One Before Surgery

Hawaii law requires hospitals to ask about advance directives during admission (under the federal Patient Self-Determination Act). If you don't have one, the hospital documents that fact and proceeds with surgery.

The risk isn't that surgery will be refused. It's what happens if complications arise:

• Without a directive: Treatment decisions fall to the surrogate decision-making hierarchy under HRS § 327E-5. Your spouse or reciprocal beneficiary, adult children, parents, siblings, and grandchildren must reach consensus. If they disagree — and families often do under ICU pressure — the matter may lead to a guardianship petition in Circuit Court.
• With a directive: Your named healthcare agent can make decisions once the directive is activated. No consensus is required, no court involvement is needed, and there is no delay while your family negotiates in the waiting room.

Who This Process Is For

• Anyone with scheduled surgery (joint replacement, cardiac procedure, cancer treatment, bariatric surgery)
• Patients entering a clinical trial where advance directives are recommended as part of informed consent
• Anyone transferring to a new hospital system and wanting their directive on file before treatment begins
• Families of elderly patients being admitted for a procedure who don't yet have a directive in place

Who This Process Is NOT For

• Emergency surgery patients (there's no time for this process — the hospital relies on the surrogate hierarchy)
• Patients who already have a valid directive on file at their surgical hospital (confirm with Medical Records that it's current)
• Patients seeking legal advice about complex medical situations (consult an elder law attorney)

Common Mistakes That Delay the Process

Submitting to admissions instead of Medical Records. The admissions desk can note that a directive exists, but Medical Records/HIM is the department that scans, indexes, and flags it in the electronic health record. Go directly to HIM.

Assuming the directive is "on file" without confirmation. Call Medical Records after submission and ask for explicit confirmation that the document is in your chart. A directive sitting in an intake pile doesn't help the surgical team.

Forgetting to bring a physical copy on surgery day. Electronic systems go down. Staff rotations happen. A paper copy in your pre-op bag is a backup your healthcare agent can hand directly to the anesthesiologist.

Using an outdated directive. If you completed an advance directive years ago and your healthcare agent or treatment preferences have changed, execute a new one. A new directive revokes prior directives to the extent they conflict.

The Hawaii Advance Directive & Living Will Kit includes hospital-specific integration instructions for Kaiser, Hawaii Pacific Health, and Queen's — helping you identify the right department, confirm its current process, and verify that your directive is flagged in the system before your procedure.

Frequently Asked Questions

How far in advance should I complete an advance directive before surgery?

There is no fixed statutory minimum. Complete it promptly, allowing time for witness screening or notary scheduling, wet-ink signing, and the hospital's current Medical Records process.

Can I complete an advance directive at the hospital on admission day?

Technically yes — some hospitals may have notary services or social workers who can help, but confirm availability. Executing under time pressure increases the risk of witness disqualification errors or missing steps. Completing it at home before admission is safer and less stressful.

Does my surgeon need a copy of my advance directive?

Your surgeon accesses it through the electronic health record. But informing your surgeon and anesthesiologist that you have a directive on file — and briefly discussing any specific treatment preferences relevant to the procedure — is good practice during the pre-op consultation.

What if my surgery is at a different hospital than where my directive is filed?

Your directive is valid statewide, but each hospital maintains its own records. Submit a copy to the Medical Records department at the facility where your surgery will take place. Don't assume it transfers automatically between systems.

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