Nursing Home Legal Affidavit

The undersigned, [Your Name], hereby affirms that:

I am currently employed as [Your Position] at [Your Company Name], a nursing home located at [Your Company Address]. In the course of my employment, I have become familiar with a resident named [Resident’s Name], who has been residing at [Your Company Name] since [Month Day, Year]. It has come to my attention that [Resident’s Name] is unable to make their own medical decisions due to [advanced Alzheimer’s disease]. As per the legal documents available with us, [Name of the Legal Guardian/Power of Attorney] has been given the authority to make medical decisions on behalf of [Resident’s Name]. This includes decisions about medical procedures, treatments, and other health-related issues.

I affirm under penalty of perjury under the laws of the state of [State Name] that the foregoing is true and correct.

Executed on this [Month Day, Year].

[Your Name]

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