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Complete Care Plan form

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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION ATLANTA, GA 30329 Complete care plan Complete THIS FORM with the information about the PERSON RECEIVING care A care plan summarizes a person s health conditions and current treatments for their care First Name: Date of birth: Age: Address: Last Name: Phone number: E-mail:About the person receiving care This information will help your caregivers to know you better and plan activities that you enjoy In a few sentences, tell people what you want them to know about you. What is your family like?

This document would be used together with the Living Will/Advanced Directive to guide your loved ones and your doctors in the event that you are unable to make your own decisions . The following documents will be attached to this Care Plan: Advanced Directive or Living Will;

  Care, Plan, Directive, Living, Care plans

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