Planning Ahead - Florida Developmental Disabilities Council

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Special equipment or assistive device(s):Device Purchased at: Maintained at: Phone NumberMethod ofPaymentSigns own consent forms for healthcare:Yes No Copies are located:Has signed an advance directive: Yes No Copies are located:Living Will: Yes No Copies are located:Health Care Surrogate: NameCopies are located:Do not resuscitate order: Yes No Copies are located:Carries a copy in wallet or purse Yes NoHas signed an organ/tissue donationcard:YesNo*Attach a copy with this Personal InformationSummaryHas been admitted to a hospital within the past five (5) years:Reason Emergency (Yes or No) Hospital (Location) DateSurgery (an operation):Reason Name of Surgeon Hospital (Location) DatePresently receiving physical or occupational therapy:Type of Therapy Therapist’s Name How Often Date StartedReceiving Mental Health service:Type of Services Physician’s Name How Often Date Started72 Section 2, The Personal Information Section
The following activity (e.g., being overheated) results in seizures:Certain activities can cause other problems (e.g., ear infections). Activity and problem that results:List preference for performing health and hygiene routines in special ways.Task NeededHow PerformedDate of adult immunizations are:Name of Immunization Date Booster(s) DateTetanus and DiphtheriaMeaslesHepatitis BFlu Shot (Influenza)Pneumonia (pneumonococcus)Special Diet:Special Food Preparation:Functions sometimes requiring assistance:Section 2, The Personal Information Section73
Page 3 and 4:
AcknowledgementsWe would like to th
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SECTION 1THE HANDBOOKDevelopmental
Page 10 and 11:
in realizing goals and outcomes he
Page 12 and 13:
• Identify agencies and organizat
Page 14 and 15:
TO BE SURE YOU HAVE ACCESSED ALL AV
Page 16 and 17:
CHAPTER THREEUsing Government Benef
Page 18 and 19:
Property or assets mean real estate
Page 20 and 21:
There is a special program for peop
Page 22 and 23:
Department of Elder Affairs: The De
Page 24 and 25:
Be sure to complete the application
Page 26 and 27:
Most services provided to persons w
Page 28 and 29: CHAPTER FIVEAdvocating and Coordina
Page 30 and 31: family member receives services. De
Page 32 and 33: • Use the chain of command. If yo
Page 34 and 35: 28ChooseYour family member may make
Page 36 and 37: 7. Skilled Nursing HomeSkilled nurs
Page 38 and 39: There are now more opportunities fo
Page 40 and 41: If your family member really thinks
Page 42 and 43: pre-need directive. As the term ind
Page 44 and 45: Can the Living Will and the Health
Page 46 and 47: Although it is not required by stat
Page 48 and 49: The potential ward, if capable of u
Page 50 and 51: LETTERS OF INTENTIn addition to hav
Page 52 and 53: TAX ISSUESIn your planning, do not
Page 54 and 55: CHAPTER TENDealing WithHealth Care
Page 56 and 57: CHAPTER ELEVENCoping with Changes a
Page 58 and 59: • Arrange visits to an area funer
Page 61 and 62: SECTION 2THE PERSONALINFORMATION SU
Page 63 and 64: Senior CenterHomemakerPersonal Care
Page 65 and 66: List relatives who are emotionally
Page 67 and 68: Recognizes danger of: (Circle those
Page 69 and 70: Do violent or sexually suggestive T
Page 71 and 72: The type of neighborhood preferred
Page 73 and 74: During the day goes to:EMPLOYMENT/R
Page 75 and 76: Provide a brief summary of Medical
Page 77: Section 2, The Personal Information
Page 81 and 82: PROTECTING LEGAL RIGHTS AND FINANCI
Page 83 and 84: Has a standby guardian been appoint
Page 85 and 86: Memorial Service: Yes No Location:S
Page 89 and 90: SECTION 3HELPFUL ATTACHMENTSDevelop
Page 91 and 92: Additional Instructions (optional):
Page 93 and 94: My Personal OutcomesWHO AM I?What g
Page 95 and 96: Bill Of RightsIn June of 1975 the G
Page 97 and 98: Stakeholders requested a change in
Page 99 and 100: Adjudicatory hearing to determinein
Page 101 and 102: Guardianship To-Do List(Step-by-Ste
Page 103: New York State Developmental Disabi
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