Privacy laws no longer allow even your spouse access to any of your medical information without your written permission. This form allows you to designate everyone you want to be able to get a general condition status update from hospitals, doctors, hospice, rehab and other facilities where you may be a patient. This is especially important after surgery or in a medical emergency. Fill this form out and give a copy to everyone on the list so they can provide a copy to the appropriate party (in person, via fax, scan and e-mail, etc.) to keep up with your condition.

This Permission only allows those you list to get more detailed medical information from physicians and other medical personnel about your medical situation. It allows you to determine the limits of the medical information to be shared.

Did you know that even your spouse isn’t allowed to pick up an x-ray, MRI or any other test, medical records, etc. for you from a doctor, hospital or other medical facilities without your written permission? When you are in the midst of significant or lengthy medical treatment or a medical emergency, you need all of the help you can get so fill this out to designate those who have your permission to lend a hand if needed.

If you are hospitalized and are unable to communicate for some period of time, only immediate family members will be allowed to visit you without written permission. Complete this form and give a copy to everyone on the list.

Privacy laws prohibit anyone else from filling your prescriptions or asking the pharmacist or other personnel questions, advice, etc. without your written permission.

Did you know that even if you get your medical insurance through your spouse’s employer that your spouse isn't permitted to discuss your benefits, reimbursements, costs, etc. or act as your advocate unless you give them written permission? The same is true for any children you have once they turn 18 even though you provide their insurance. The same is true for all types of insurance. If something happens and you are unable to manage your affairs for some period of time, it’s important that one or more people have your permission to have access to your insurance information and can act as your advocate.

Just as is the case with any private insurance, no one can help you with the benefits, cost, or other matters affiliated with government sponsored benefits like Social Security, Medicare, Medicaid, etc. without your written permission.

When you are giving or receiving care from others for some period of time, it’s essential that others have the information and instructions needed to give the primary caregiver a break on a regular basis. This form allows you to easily put that information in writing so any number of other people can provide the breaks on a regular basis.

It’s not only important that the primary caregiver of someone who requires longer term care get more lengthy and regular breaks, but it’s essential to maintain up-to-date written care giving information and instructions in the event that the primary caregiver has their own medical or other emergency or crisis which results in the need for others to assume their responsibilities for some period of time.

This form makes it easy for one or more care givers to keep track of the dietary requirements and medication schedule of the person under their care.

The goal for most of us is to be able to stay in our own homes as we age or if we are facing medical and other challenges. The secret to achieving this goal is to get help when needed, whether from friends and family members or from other sources and organizations as it can truly “take a village” to get the assistance we need or to be able to help others. This form allows you to easily keep track of “who does what” which is essential when help comes from multiple sources.

There are many instances when you may have to spend time in one of these facilities as a result of an unexpected event like a car or other accident, stroke, heart attack or other medical emergency until you are well enough to return home. The quality of these facilities can vary significantly and you could find yourself in a really unfortunate situation if you don’t take the time to research the available options in your community and make a written list your preferences so you are prepared for the unexpected.

Just as with your healthcare, insurance, and other key parts of your life, it’s important that you have an advocate as your backup while residing in any of these facilities so, if needed, they can make certain that you are getting the care you deserve as well as deal with any financial or other issues if necessary.

When the unexpected happens, designated individuals need to be able to provide critical legal and advanced directives to the appropriate parties.

(Go to “LEGAL RESOURCES” from our Home Page): When choosing who to give your healthcare power of attorney to, remember that the person you select should be someone with whom you’ve had a lengthy conversation about what you would want under specific situations if you were unable to make your own healthcare decisions. Not only should they be willing to make the kinds of decisions you would make for yourself if you were able, but these decisions shouldn’t be in conflict with their own personal beliefs.

Living Smart isn’t a legal resource nor does it give legal advice or provide legal documents. However, we believe that every adult should have a healthcare power of attorney so we listed several internet legal firms on the LEGAL RESOURCES page of the website that offer this free document. We are in no way affiliated with these companies nor can we attest to their legal capabilities.

(Go to “LEGAL RESOURCES” from our Home Page) Please see 16 above.

(Go to “LEGAL SOURCES” from our Home Page) Please see 16 above.

Although none of the above tools are legal documents, it’s possible that someone may ask you to include a notary with one of the completed forms for their records. Just print out the notary form, attach it to the completed but unsigned Living Smart form and take to a notary for you both to sign.