|
Sample Care Log
|
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| LA - located and available | UD - needs to be updated | C - make a duplicate |
| LN - located, but not available | GD - get document | L - lost, request duplicate |
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DOCUMENTS |
STATUS |
COMMENTS |
| Legal documents | ||
| Birth Certificate |
________
|
|
| Social Security card |
________
|
|
| Marriage license(s) |
________
|
|
| Divorce decree(s) |
________
|
|
| Military records |
________
|
|
| Will |
________
|
|
| Living will |
________
|
|
| Power of attorney |
________
|
|
| Health care power of attorney |
________
|
|
| Legal agreements |
________
|
|
|
|
||
| Checking account |
________
|
|
| Savings account |
________
|
|
| Retirement account |
________
|
|
| Stock certificates |
________
|
|
| Savings bonds |
________
|
|
| Real estate deed/title |
________
|
|
| Automobile title |
________
|
|
| Investment income |
________
|
|
| Other income |
________
|
|
| Mortgage statement |
________
|
|
| Property tax statement |
________
|
|
| Lease agreement |
________
|
|
| Utility & phone statements |
________
|
|
| Doctor/hospital bills |
________
|
|
| Credit cards |
________
|
|
|
|
||
| Auto |
________
|
|
| Homeowners |
________
|
|
| Life insurance |
________
|
|
| Medicare |
________
|
|
| Medigap |
________
|
|
| Long-term care |
________
|
|
| Disability |
________
|
|
| Liability |
________
|
|
|
Other ________________________________________ |
||
| Other ________________________________________ |
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Compiled by the Lincoln/Greater Nebraska Chapter of the Alzheimer's Association, 1999.