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: |
