Senior Health and Emergency Information Kit |
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A USEFUL TOOL
The Senior Health Info Kit is essentially a convenient, organized, digital "container" for all the medical information you might need to refer to before, during, or after a doctor visit. Download the forms by clicking below, fill in your information (your own or your parents'), and then store them in a single binder or folder that you can grab on your way to the doctor.
Choose a PDF to print and complete by hand, or a Word doc to fill in on your computer, save, and print. PERSONAL INFORMATION
A section for your contact information, physicians, emergency contacts, and known allergies.
DOCTOR & PHARMACY INFORMATION
A place to list contact information for physicians, pharmacists, dentists, and more.
LEGAL HELP & INFORMATION
A section for storing the contact information for your attorney and executor, as well as photocopies of your Durable Power of Attorneys and Advance Directives.
DOWNLOAD THE COMPLETE KIT
If you know you would like to use all the above forms, click the below to download them as a single, convenient document.
 Download PDF Download Word Doc
To request a complete printed version of our health info kit be mailed to you or if you have an idea for a form that is not yet included, please email us and let us know. |
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Other Important Documents
Every person's health situation is unique, but the following forms are commonly needed in health situations. As you are assembling your Senior Health Info Kit, consider including the forms listed below. (When you download the Senior Health Info Kit, you'll find instructions about where to include these photocopied forms): Durable Power of Attorney
for Health Care - ILLINOIS A Power of Attorney for Health Care document allows a person to delegate the power to make decisions regarding his own health care. The document may be used instead of or together with a Living Will. Durable Power of Attorney
for Health Care — Q and A This document from the Illinois Department on Aging gives thorough but easy-to-understand answers to common questions about the Durable Power of Attorney for Health Care document. Durable Power of Attorney
for Property - ILLINOIS A Power of Attorney for Property document allows a person to delegate the power to make decisions regarding assets, finances, and real estate. Durable Power of Attorney
for Property — Q and A This document from the Illinois Department on Aging gives thorough but easy-to-understand answers to common questions about the Durable Power of Attorney for Property document. Do Not Resuscitate (DNR)
If you decide you do not want CardioPulmonary Resuscitation administered during an emergency, complete this form to indicate your preferences. MICHIGAN Guide to Medical
and Legal Decisions A booklet designed to help Michigan residents pre-plan, with question-and-answer sections, general information, and forms on Michigan's Statutory Will and Patient Advocate law and organ donation. Five Wishes
This document may be used instead of a Living Will or Durable Power of Attorney for Health Care. It is a simplified form that lets you indicate (1) who you want to make care decisions for you when you are unable, (2) what kind of medical treatment you want, (3) how comfortable you want to be, (4) how you want people to treat you, and (5) what you want your loved ones to know. |
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