Free Personal Care Profile

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Personal Care Profile

Allergies


Allergies



Frequently Asked Questions
Why is discussing my allergies helpful?Including information about your allergies and how to treat them will help your caregiver keep you safe.


Your Personal Care Profile

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PERSONAL CARE PROFILE

for ____________________________ of __________, Virginia

These guidelines outline the activities and pursuits that give ____________________________’s life meaning. This document may also include personal beliefs, such as religion or spirituality, and preferences for how ____________________________ likes to be interacted with. Caretakers can use this information as a guide when performing their role and to enhance ____________________________’s quality of life.

This document is not intended to be interpreted as a Last Will and Testament or Living Will. These guidelines are only intended to help family and caretakers in ensuring ____________________________’s senior years are fulfilling.


MISCELLANEOUS

Interaction
I have no preferences for how caretakers interact with me.

Veteran
I am not a military veteran but may be eligible for benefits through Medicaid and state-sponsored programs such as the Program of All-Inclusive Care for the Elderly.

Personal Belongings
I have not recorded the personal belongings I have with me.

SIGNING

I recognize that it may not be possible for my appointee to fulfill all of my wishes and request that my caretakers act to follow the spirit of these wishes as well as they can and within the limits of any applicable law.

Signature

Date:

_________________________

________________ ____, ________

____________________________

 

Last updated September 16, 2024


Related Documents

  • End-of-Life Plan: a document that describes how you want your body to be dealt with after you pass away, as well as the services that you want held in your name
  • Living Will: a document that outlines your preferences regarding health care treatments or appoints a personal representative to make health care decisions on your behalf
  • Last Will and Testament: a document that specifies how you would like your property and assets to be distributed after you pass away
  • Power of Attorney: a document that grants authority to someone so they may manage legal and financial affairs on your behalf
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Personal Care Profile

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