Confronting
Life Threatening Illness
By John Whitacre
The Pierian Press:
Ann Arbor, Michigan: Ph: 1800-678-2435, $12.95 US plus shipping
Copyright © 1992, 1997 John Whitacre. All rights
reserved.
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Check List No. 1: Medical Crisis Check List
Disclaimer: This list is meant to be a thought process guide. Although many items are
covered, your needs are unique. Important and unique items for your crisis may be not be
included in the following check list.
INDEX:
Check List No. 1: Medical Crisis Check List
Disclaimer: This list is meant to be a thought process guide. Although many items are
covered, your needs are unique. Important and unique items for your crisis may be not be
included in the following check list.
I. Select Medical Team and Medical Treatment Goals
and Path
- Establish partnership with doctors
- Make list of your medical needs and questions and discuss with doctor
- Get facts for your particular illness
- Discuss what to expect with progression of illness with medical team
- Make list of all medications you are taking
- Discuss with doctors (Work Sheet No. 1)
- Dosage levels
- Instructions for taking
- Make personal assessment of effectiveness for purpose taken
- List any side effects you need addressed
- Discuss available treatments with medical team
- Determine your goals and discuss your options
- How to go for a cure
- How to go for maximum life span
- How to go for maximum quality of life
- Other
- Determine the best action or compromise for you
- Make medical/home support key contacts list (Work Sheet No. 2)
- Emergency
- Doctors
- Caregivers
- Nursing services
- Pharmacies
- Medical supplies
- Hospitals
- Ambulance
- Hospice
- Other
II. Review/Make Key Legal Decisions and Get Legal
Documents Reviewed/Prepared by Attorney
- Designate proxy medical decision maker - your person of choice
- Durable power of attorney (Harvard Medical Directive or Other)
- Document/communicate how you want to treated medically
- Living Will/medical directive (Harvard Medical Directive or Other)
- Designate/provide for handling of finances, a proxy financial
representative, your person of choice
- Living Trust
- Durable Power of Attorney
Other Important Legal Actions to Consider
- Select how you want to distribute major assets in event of your death
- Will/codicil/living trust/trust
- Designate guardian for minors
- Establish trust for minors, other if desired
- Select how you want to distribute minor assets and possessions to
family and others to avoid squabbles and hurt feelings
- Will/codicil
- Memorandum to your executor of estate (Work Sheet No. 5)
III. Make List For Key Legal, Business and
Financial Contacts (Work Sheet No. 3)
- Attorney
- Accountant
- Stockbroker
- Investment Adviser
- Bank Officers
- Guardians
- Life insurance
- Medical insurance
- Home/rental insurance
- Auto insurance
- Banks
- Social Security
- Work
- Other
IV. Consolidate Important Documents in One Place
(Work Sheet No. 4)
- Will
- Codicil to will
- Memorandum to executor of your estate
- Letter of instructions
- Living will
- Durable power of attorney
- Birth certificates
- Passports
- Insurance policies
- Stocks
- Bonds
- Titles
- Deeds
- Mortgages
- Loan record
- Tax records and tax documents
- Other important and other legal papers
V. Establish Sense of Financial and Medical
Security for Self and Family (Work Sheet No. 6)
Determine financial/medical support system available. Understand
personal assets, resources and benefits available to you.
- Financial
- Income - all sources
- Earned
- Work sick leave
- Retirement
- Investment/interest
- Social Security
- Disability insurance
- Other
- Expenses - All Sources
- Assets - all sources
- Bank accounts
- Safe deposit box
- Stocks
- Bonds
- Property
- Business
- Other
- Liabilities
- Mortgages
- Loans
- Credit cards/accounts
- Other
- Medical
- Details of medical insurance plan
- Medicare
- Medicaid
- Other
VI. Choose Caregivers and Proxies [note: one
person can fill all these rolls] (Check List No. 2)
- Proxy medical decision maker
- proxy financial representative
- Guardian for minors
- Close family member
- Other relative
- Friend
- Other legal choices
VII. Select Techniques/Methods to Maximize
Quality of Time Left
What is important to you (within abilities/constraints of your illness
and resources). Items that enhance quality of life and provide hope.
- Happy, joyful objectives (Work Sheet No. 7)
- Special, memorable objectives (Work Sheet No. 8)
- Productive objectives and accomplishments (Work Sheet No. 9)
VIII. Make a List of Contacts for
Social/Emotional Support (Work Sheet No. 10)
- Close family member
- Other relatives
- Friends
- Work associates
- Church associates
- Other
IX. Select Setting and Support System for Recovery
or in Event of Death
- Hospital
- Nursing home
- Hospice
- Your home - supported
- Doctor/Nursing
- Hospice
X. Make a List of Contacts to Notified in Event of
Death
- Close family members
- Other relatives
- Friends
- Work associates
- Other legal/business/and financial key contacts
- Insurance companies
- Social security
- Funeral home
- Cemetery
- Other
XI. Make Funeral/Memorial Service Decisions in
Event of Death
- Select funeral home
- Method of body disposal-burial/cremation
- Select grave site/location/method to handle remains
- Document/communicate and special wishes for services (special
readings, music, etc.)
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Copyright © 1992, 1997 John Whitacre. All rights
reserved.