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Decisions and Documents

Fill this in with your person, and confirm with the team where each document belongs.

Module 5

Health care proxy: name and phone

Living will or advance directive: where the original is kept

POLST or DNR: where it is kept, and who has copies

Funeral home, if chosen

Wishes for after death: burial, cremation, organ donation, rituals, who should be called

Date reviewed, and with whom