Page 237 - CHHA Binder 2.3.20

4/11/2019

Paperwork and Tools

The 3 binder colored coded
rd
in blue forms and papers that
need to be handed out if
needed. There is also a Thank
you card signed by the
members of the care team to
be given to the patient at
discharge.
35

Health Care Proxy Form

As discussed earlier,
if the patient would
like to designate a
Health Care Proxy,
this form should be
filled out.

VNSNY employees should not sign the form as a witness.
Patient must sign in the presence of 2 witnesses who know the patient (can be MD
or lawyer if patient would like).
Copies must be given to:
Health Care Proxy
MD
Lawyer
Family Member (if patient chooses)
Patient keeps copy in easy to locate place (wallet, nightstand, etc).
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