General Use Downloads

Directive to Physicians and Family or Surrogates | PDF

Also known as the Living Will, this document allows the patient to direct the physician in the care expected. Family members cannot overrule the instruction given in this directive.

The Medical Power of Attorney | PDF

This document appoints an individual and a back up person to make specific decisions on behalf of the patient. The patient must no longer be competent to make decisions and instructions to the healthcare professionals in order for this to take effect. The person who has the medical power of attorney cannot overrule the wishes of the now incompetent resident, but must follow the guidelines which were set up prior to incompetence.

Document for the Incompetent Person | PDF

This document directs the professionals as to what the family believes would have been the choice for care if the question had been resolved prior to incompetence.

Out of Hospital DNR | PDF

This document is used to let health care providers and EMS know that the resident is not to be resuscitated. This means that CPR will not be administered. Family members cannot override the instructions given by the resident or individual. However, if a DNR was not completed by the individual the law provides for an eligible relative or surrogate to compete it on the resident’s behalf. 

Inquiry Downloads

Golden Age Home Inquiry Form | Word Document

This document is used to collect personal information and current medical condition of prospective residents.

Inquiry Booklet | Word Document


Admissions Downloads

Service Agreement | Word Document

Lease Agreement | Word Document

Information Received Prior to Admission | Word Document

Admission Checklist | Word Document

Admission Medical Form | Word Document