End Of Life Care Plan
End Of Life Care Plan
I. Personal Information
A. Basic Details
Full Name: [YOUR FULL NAME]
Date of Birth: [YOUR DATE OF BIRTH]
Place of Birth: [YOUR PLACE OF BIRTH]
B. Contact Information
Address: [YOUR CURRENT ADDRESS]
Phone Number: [YOUR PHONE NUMBER]
Email: [YOUR PERSONAL EMAIL]
II. Medical Information
|
Category |
Information |
|---|---|
|
A. MEDICAL HISTORY |
|
|
Primary Care Physician |
[YOUR PRIMARY PHYSICIAN] |
|
Known Medical Conditions |
[YOUR MEDICAL CONDITIONS] |
|
Current Medications |
[YOUR MEDICATIONS] |
|
B. ADVANCED DIRECTIVES |
|
|
Living Will |
[YES/NO] |
|
Power of Attorney |
[HOLDER'S NAME AND CONTACT INFORMATION] |
|
Do Not Resuscitate (DNR) Order |
[YES/NO] |
III. Legal Information
A. Legal Contacts
Attorney: [YOUR ATTORNEY'S NAME]
Contact Information: [ATTORNEY'S CONTACT INFORMATION]
B. Important Documents
Will: [LOCATION OF WILL]
Trust Documents: [LOCATION OF TRUST DOCUMENTS]
Insurance Policies: [LIST OF POLICIES AND LOCATIONS]
IV. Financial Information
A. Financial Contacts
Financial Advisor: [YOUR FINANCIAL ADVISOR]
Contact Information: [ADVISOR'S CONTACT INFORMATION]
B. Financial Accounts
Bank Accounts: [LIST OF BANKS AND ACCOUNT NUMBERS]
Investment Accounts: [LIST OF INVESTMENT ACCOUNTS]
V. End of Life Wishes
|
A. FUNERAL PREFERENCES |
Information |
|---|---|
|
Preferred Funeral Home: |
[PREFERRED FUNERAL HOME NAME] |
|
Burial or Cremation: |
[BURIAL/CREMATION] |
|
Special Requests: |
[SPECIFIC REQUESTS FOR FUNERAL, E.G., MUSIC, READINGS, FLOWERS, ETC.] |
|
B. MEMORIAL SERVICE |
Information |
|---|---|
|
Ceremony Type: |
[RELIGIOUS/NON-RELIGIOUS] |
|
Location: |
[PREFERRED LOCATION, E.G., CHURCH, PARK, HOME, ETC.] |
|
Speakers: |
[DESIRED SPEAKERS OR EULOGISTS] |
VI. Personal Messages
A. Letters to Loved Ones
Spouse/Partner: [MESSAGE]
Children: [MESSAGE]
Parents: [MESSAGE]
B. Legacy Wishes
Charitable Donations: [PREFERRED CHARITIES]
Memorabilia: [ITEMS TO BE GIVEN TO SPECIFIC PEOPLE]
VII. Final Checklist
-
Review all medical and legal documents for accuracy.
-
Ensure all key contacts are informed and have necessary information.
-
Communicate wishes with family and loved ones.
-
Store all critical documents in a secure and accessible location.
