make your free elder care authorization form
other names:
authorization for eldercare
elder care authorization
authorization of care
elder care directive
what is an elder care authorization form?
an elder care authorization form is a document that grants a caretaker temporary custody of an older adult who needs elder care.
when to use an elder care authorization form:
- you want to designate someone to take care of an elderly adult person.
- you want to provide specific authority and powers to the caretaker.
- you want to provide emergency contact information.
sample elder care authorization form
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elder care authorization
i, the undersigned , hereby grant:
(the "caretaker),
,
the authority to take temporary care of the following adult: . i grant this authority in my capacity as 's . my contact information is as follows:
,
this grant of temporary authorization to provide elder care shall begin on , and shall remain effective until terminated by the undersigned.
the caretaker shall have the power to:
| other instructions: |
in an emergency situation, please contact the following person:
| name: |
| address: |
,
| phone number: |
if that person is not available, please contact the following alternate choice:
| name: |
| address: |
,
| phone number: |
| by: | date: |
