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.
Plan Templates @ Template.net
