Portal, AZ - Rodeo, NM
Serving The Communities Of Portal and Rodeo (www.portal-rodeo.com)
Forms You May Download
Internet Links For Additional Forms
Living Will & Durable Healthcare Power of Attorney (AZ)
Anyone completing the AZ form does NOT have to have it notarized, but best to have 2 witnesses sign as AZ requires only one but NM requires 2 (just in case we wind up in the SIlver City hospital).
Living Will & Durable Healthcare Power of Attorney (NM)
Get Large Ziplock Bag
Put all important completed Papers inside it (essential list below), seal tightly.
Store in freezer top shelf at one of the sidewalls.
1. Portal Rescue info on calling 911 (*tell operator which county you are in!), good to put 911 calling info next to household phone too.
2. Copy of File of Life for each household resident (also tape original to outside of fridge).
3. Copy of all household members Driver’s licenses & Medical Insurance Cards, completed Living Wills, Power of Attorney for Healthcare, & HIPPA forms*.
4. Emergency Support Contacts list!!
5. Pet care coverage specifics: caretakers/vet phone #s, leash/bed/food/medicine info.
*Portal Library will provide free packet of forms. Individuals must xerox personal licenses &
insurance cards, plus may need or want more blank HIPPA copies for coverage at a number of
“local” medical facilities: Portal Clinic, Douglas, Bisbee, SierraVista, Silver City, TMC, Banner UMC.
Emergency Support Contact List specifics:
-line up & list several local residents who agree to help in an emergency, provide them with: copy of your house key or info on hidden key location, where you keep checkbook/cash & other important paperwork that is not in your freezer ziplock bag (general Power of Attorney, Will, SS#) **have your main contact person notify your long distance contacts and your primary care provider if you were transported to a hospital.
-list long distance emergency kinfolk/close friends names & contact numbers; send them your local contact names & phone numbers.
Suggestions: prepare supply list for patient (& companion) during hospital/lodging stay and/or after discharge, note where these items are kept in the home. The list might include things like suitcase, clothes/underwear/shoes, personal hygiene items, glasses, hearing aids, address/phone # book, cell phone/computer/iPad, chargers, wallet, books, water bottle, approved snacks etc, other supplies like pillow/blanket for drive home, including cane/walker/wheelchair if needed. Be certain all costly items are secure from theft.