I have a regular one, but not a psychiatric one. I think probably most or all states have them, though I don't know the degree of recognition one from state A would receive in state B. It probably varies according to state how they recognize other state's ADs. I made out a new one when I moved from one state to another. They had considerably different procedures. In one you filled it out, got it witnessed, notarized and sent it in to the state, were in a registry and received a card for your wallet. In the other, you filled it out, made a few copies to distribute as you pleased and that was that(!) I keep a hand written card in my wallet about it (who's in charge, where the document is located, etc). I'd imagine the psychiatric ones vary from place to place like the regular ones do. It really is good to say what you want before the need arises. (It's the ONLY thing like that I'm "together" in doing, lol.)