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1. Title and Introduction: Formal introduction stating this is an affidavit, including the jurisdiction and date
2. Affiant Information: Personal details of the person making the affidavit (caregiver), including full name, address, and identification
3. Relationship Declaration: Statement of the relationship between the caregiver and the person receiving care
4. Care Recipient Information: Details of the person receiving care, including full name, age, and current residence
5. Authority of Caregiver: Specific powers and responsibilities granted to the caregiver
6. Duration of Caregiving Arrangement: Timeframe for which the caregiving arrangement is valid
7. Healthcare Decisions: Scope of medical decision-making authority granted to the caregiver
8. Emergency Contact Information: List of additional contacts in case of emergencies
9. Attestation: Formal statement affirming the truth of the contents
10. Signature Block: Space for signatures, witness details, and notarization
1. Financial Authority: Details of any financial responsibilities or authority granted to the caregiver, used when financial management is part of the caregiving duties
2. Educational Decisions: Authority regarding educational decisions, included when the care recipient is a minor or student
3. Travel Authorization: Permission for domestic or international travel with the care recipient, included when travel may be necessary
4. Religious Preferences: Specific religious or cultural considerations in caregiving, included when religious/cultural aspects are important to the care arrangement
5. Temporary Housing Arrangements: Details about living arrangements, included when the caregiver will provide housing
6. Revocation Terms: Specific conditions under which the affidavit can be revoked, included when special termination conditions exist
1. Schedule A - Medical History: Detailed medical history and ongoing medical conditions of the care recipient
2. Schedule B - Medication List: Current medications, dosages, and administration schedules
3. Schedule C - Emergency Protocols: Specific procedures to follow in various emergency situations
4. Schedule D - Daily Care Requirements: Detailed description of daily care needs and routines
5. Appendix 1 - Identity Documents: Copies of relevant identification documents for both parties
6. Appendix 2 - Medical Powers: Detailed scope of medical decision-making powers
7. Appendix 3 - Contact List: Comprehensive list of medical providers, family members, and emergency contacts
Healthcare
Social Services
Legal Services
Elder Care
Child Care
Medical Services
Education
Family Services
Non-Profit/Charitable Organizations
Insurance
Legal
Healthcare Administration
Social Services
Human Resources
Compliance
Patient Services
Family Support Services
Risk Management
Documentation
Care Coordination
Healthcare Administrator
Social Worker
Legal Counsel
Family Services Coordinator
Elder Care Specialist
Child Care Provider
Medical Director
Human Resources Manager
Care Coordinator
Patient Services Representative
Legal Administrator
Family Support Specialist
Healthcare Compliance Officer
Residential Care Manager
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