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How to Register an Advance Directive

By Jason Su · Updated October 30, 2026

Registering an advance directive is voluntary, and your form is valid whether or not you register it. What registration adds is reach: a way for a hospital or provider to pull up your wishes quickly when you cannot speak for yourself. Only a handful of states run an official registry, so the first question is whether yours does.

What a registry is — and what it is not

A registry is a secure database where a copy of your advance directive is stored, so that an authorized health care provider can retrieve it in an emergency. The copy is the point. The original stays with you or in your files, and the registry holds a way to find it.

A registry does not make your directive valid. The document becomes valid the moment it is properly signed and witnessed, under your state’s rules. Registration is an added convenience, never a requirement.

It is also not a substitute for telling people. The person you named as your agent should still have a copy, and your family should still know the document exists. A registry is a backup, not the main plan.

Registration is voluntary — your form is valid either way

This is the line every state that runs a registry states plainly: you do not have to register, and skipping it does not weaken the document.

North Carolina’s Secretary of State, which runs that state’s registry, says registration is entirely voluntary. Vermont’s Department of Health says the same — your directive is valid as soon as it is signed and witnessed, whether or not a copy is on file.

So if your state has no registry, or you never get around to filing, nothing is lost. You have an advance directive, and it works. Registration only changes how fast a stranger in a hospital can find it.

For the basics of what the document itself is and does, start with what is an advance directive.

Which states run a registry

Most states do not run an official advance directive registry. A minority do, and the list is the useful part:

• North Carolina — the Secretary of State keeps the registry.
• Vermont — the Department of Health runs the Vermont Advance Directive Registry.
• Virginia — the state maintains a registry through its advance directive program.
• Montana — the state runs an End of Life Registry.
• Arizona — the Arizona Healthcare Directives Registry (AzHDR).
• Idaho, Louisiana, and North Dakota also offer registration.

In states without one, the options are different: some health systems keep their own internal files, and some private services offer nationwide storage for a fee. Neither is required, and neither replaces the original document.

Because this list changes, confirm with your own state’s health department or secretary of state whether a registry exists and how to file. If your state is not listed, the practical answer is usually: keep the original with your agent and your family, and give a copy to your doctor.

How to register, step by step

The steps are short and mostly the same across states.

1. Confirm your state has a registry. Search your state’s health department or secretary of state for “advance directive registry.”
2. Complete and sign your directive first. Registration files a copy of an already-valid document, so the signing and witnessing come first.
3. Get the registry’s form. Most states have a registration form to fill in alongside the document.
4. Send the form and a copy. Usually you mail it, upload it, or fax it, depending on the state.
5. Expect a card or confirmation number back. Many registries send a wallet card or a registration number for the person’s file.

There is often a small fee for filing — some states charge around ten dollars per document, some file it free. The state’s own page will say, and it is a one-time cost rather than a subscription.

How to update or revoke

Life changes, and so do wishes. A registry is only useful if what is on file matches what you want now.

To update, you generally file the newer signed document the same way you filed the original. The new copy replaces the old one on record. Some states have a change form for exactly this.

To revoke, you tell the registry to remove your directive. This usually means a written notice, and it is separate from revoking the document itself. A directive can also be revoked in other ways — in writing, verbally, or by destroying the original, depending on your state — and if you do that, the registry copy should come down too.

The rule that matters: when you change your directive, change the registry at the same time. A hospital that pulls an old copy will act on what is on file.

The registry and the original, side by side

	The original document	The registry copy
Where it lives	With you, your agent, or your files	A secure state database
Who sees it	Whoever you give it to	Authorized providers in an emergency
Does it make the directive valid?	Yes, once signed and witnessed	No — it only stores a copy
What happens when you update	You sign a new one	You file the new copy

Both matter, for different reasons. The original is the legal document. The registry is the findable one. Most people need the original with their agent, and — if their state allows — a copy on file.

Who should hold the original — and who should know

A registry is a backup, not the main plan. The document that actually speaks for you is the signed original, and it needs to be where someone can find it.

Give one copy to the person you named as your agent, and tell them where the original lives. Give another to your primary care doctor, so it is already in your medical record before anything happens. Tell your family the document exists, even if you do not share every detail.

The pattern that fails is the one people fall into most: a signed directive that sits in a drawer, and a family that does not know it is there. A registry helps a hospital find it. A copy in your agent’s hands helps everyone else.

A note on POLST, which is different

A POLST form looks related but is a separate document, and it is worth keeping the two straight.

An advance directive says what you want and who decides for you. A POLST — a medical order, sometimes called a POST or MOLST depending on the state — is a set of standing medical orders signed by a clinician, meant to be acted on right away in a serious illness. Some states have a separate registry for POLST forms, and the rules are different. See what is a POLST form for the distinction.

If your state has both, register them separately and keep track of which is which.

What not to do

• Do not assume registration makes your directive valid. It does not. Signing and witnessing do.
• Do not rely on the registry alone. Give the original to your agent and tell your family.
• Do not register once and forget it. Update the copy when your wishes change.
• Do not confuse a POLST form with an advance directive. They are different documents with different rules.
• Do not pay a private service if your state has a free or low-cost official registry.

Frequently asked

Do I have to register my advance directive?

No. Registration is voluntary, and the document is valid without it. Registration only helps providers find it quickly.

Does registering cost money?

It depends on the state. Some file it free; some charge a small one-time fee. The state’s registry page will say.

Who can see my directive once it is registered?

Only authorized providers and facilities, in an emergency or when you are under their care. The copy is stored securely, not posted publicly.

How do I change a registered directive?

File the newer signed document with the registry the same way you filed the original, or use the state’s change form. The new copy replaces the old one.

How do I remove my directive from a registry?

Send the registry a written notice to revoke, separate from revoking the document itself. If you revoke the document, also remove the registry copy.

What if my state has no registry?

Keep the original with your agent and your family, and give a copy to your doctor. That is the standard approach in most states.

Next step

Find out whether your state runs a registry — one search for your state’s name plus “advance directive registry.” If it does, and your directive is already signed, file a copy this week. If it does not, make sure your agent and your doctor each have a current copy instead.

Either way, confirm the document itself is up to date first. If you have not yet named an agent, see what to do if you are named as a healthcare agent and the advance directive vs. living will vs. health care proxy comparison, then check your state’s official name for the form on the free state name reference.

This is general information, not legal or medical advice. We are not a law firm. Registry programs, fees, and forms differ by state and change over time — please confirm details with your state’s health department or secretary of state and talk with a licensed professional about your situation.