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Who are you caring for?
Which best describes their mobility?
How well are they maintaining their hygiene?
How are they managing their medications?
Does their living environment pose any safety concerns?
Fall risks, spoiled food, or other threats to wellbeing
Are they experiencing any memory loss?
Which best describes your loved one's social life?
Acknowledgment of Disclosures and Authorization
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington. Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services. APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid. We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour. APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment. You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints. Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights. APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.I agree that: A.I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information"). B.APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink. C.APFM may send all communications to me electronically via e-mail or by access to an APFM web site. D.If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records. E.This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year. F.You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
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I acknowledge and authorize
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I consent to the collection of my consumer health data.*
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I consent to the sharing of my consumer health data with qualified home care agencies.*
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Mostly Independent
Your loved one may not require home care or assisted living services at this time. However, continue to monitor their condition for changes and consider occasional in-home care services for help as needed.
Remember, this assessment is not a substitute for professional advice.
Share a few details and we will match you to trusted home care in your area:
50sChild, that is why most states now require training for any Guardian. americanbar.org has links to state rules at http://www.americanbar.org/content/dam/aba/uncategorized/2011/2011_aging_gship_st_hbks_2011.authcheckdam.pdf
Yes, pay $1500-$5000 and no instruction exactly how to execute anything. Then call lawyer to ask and get another $200 bill. Call the payee and ask them. Then it is their problem.
As everyone else as said, Your Name and POA. I have been my Mom's for a couple of years now. I made it a point to send copies of mine to people that I knew I would have to deal with by phone. Mortgage Company, Utilities, ETC. According to your circumstances you may want to take a copy to the Pharmacy and give them a list of authorized people that can pickup medications. I had to do this in order to keep a particular sister from getting Mom's pain med's for herself. I can't tell you how much this helped cutout the crap she was pulling. It was either do that or I was going to hunt her down and choke her.
your name and the words “Power of Attorney” Dxxxxxxxxxxxxxxx, Power of Attorney for Dxxxxxxxxxxxxxx
sign the principal's name for him on the signature line. Below his name, write "By" followed by your signature. Next to your signature write in "POA for" which stands for power of attorney, and then write the name of the principal.
Dxxxxxxxxxxxxxxxxxxxxx by Dxxxxxxxxxxxxxxxxxxxxx POA
In Massachusetts, if Charles Smith granted a POA to Judith Quinn, Judith would sign Charles Smith's name on the signature line of any legal document and below the line should be the notation, Dxxxxxxxxxxxxxxxxxxx by Dxxxxxxxxxxxxxxxx, Attorney-in-Fact, POA for Dxxxxxxxxxxxxx
"by Judith Quinn as Attorney-in-Fact for Charles Smith". A copy of the POA may be requested by the other party to the document.
I usually sign his name, then off to the end of it put a slash, and POA. I've noticed more and more medical documents have "Patient Representative" in which case you sign your name.
It might depend upon the document you're signing. I was POA for my dad and I remember signing my name then "POA" after my signature but whoever you're dealing with will let you know how to sign the document.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
http://www.americanbar.org/content/dam/aba/uncategorized/2011/2011_aging_gship_st_hbks_2011.authcheckdam.pdf
your name and the words “Power of Attorney”
Dxxxxxxxxxxxxxxx, Power of Attorney for Dxxxxxxxxxxxxxx
sign the principal's name for him on the signature line. Below his name, write "By" followed by your signature. Next to your signature write in "POA for" which stands for power of attorney, and then write the name of the principal.
Dxxxxxxxxxxxxxxxxxxxxx by Dxxxxxxxxxxxxxxxxxxxxx POA
In Massachusetts, if Charles Smith granted a POA to Judith Quinn, Judith would sign Charles Smith's name on the signature line of any legal document and below the line should be the notation,
Dxxxxxxxxxxxxxxxxxxx
by Dxxxxxxxxxxxxxxxx, Attorney-in-Fact, POA for Dxxxxxxxxxxxxx
"by Judith Quinn as Attorney-in-Fact for Charles Smith". A copy of the POA may be requested by the other party to the document.
Read more: wiki.answers/Q/How_do_you_sign_when_you_have_power_of_attorney#ixzz22c3YkP6O
Some places will not accept POA ask them ......