A free printable advance directive contact sheet for organizing decision-maker contacts, document locations, primary doctor, family contacts, and hospital or facility document notes.
This may be called an advance directive contact list, health care proxy contact sheet, living will document location sheet, POLST/MOLST location note, or caregiver decision-maker contact printable.
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Advance Directive Contact Sheet preview
Who this printable is for
Adults, older adults, caregivers, families, people with serious illness, and households that want decision-maker contacts and document locations easy to find without interpreting legal documents.
Why this may matter in an emergency
Important paperwork and contact details often live in different places: wallets, portals, phones, binders, pharmacies, clinic records, insurance cards, device folders, and family memory.
A concise printable can help a family member, caregiver, urgent care team, ER team, EMS team, or trusted helper find the right contact or source document faster without pretending to be the source document.
Advance directive handoff notes
Use these notes to help trusted people locate contacts and documents. Do not use the sheet to create, modify, interpret, or summarize legal documents or medical orders.
Who is listed as the decision-maker or trusted contact, if the person chooses to record it
Where documents are stored and whether a facility, doctor, or family member may have a copy
Who can confirm whether a copy is current
What not to include: legal advice, treatment instructions, document interpretation, or promises that a document will be accepted
Where to keep it
Keep copies where trusted helpers know to look, such as a home emergency folder, caregiver binder, go-bag, wallet or purse, refrigerator copy if appropriate, equipment folder, or with a trusted family contact.
If the sheet may be visible to visitors, use locations and contact notes instead of sensitive numbers, passwords, door codes, or unnecessary private details.
When to update it
Review the sheet when contacts, cards, portal names, pharmacy details, doctors, medications, allergies, equipment, documents, caregiver roles, or record locations change.
It may also be worth reviewing after a hospital discharge, new diagnosis, new device, insurance change, pharmacy change, new caregiver, travel plan, or major household update.
Privacy and safety notes
Share only what is useful for emergency organization and handoff. Avoid printing passwords, security answers, full Social Security numbers, financial account numbers, door codes, or unnecessary sensitive details.
This page is for emergency information organization and preparedness only. It is not medical advice, legal advice, insurance advice, billing advice, claims advice, medication advice, device advice, diagnosis advice, or treatment guidance. It does not replace 911, EMS, clinicians, medical records, medication labels, patient portals, insurance cards, legal documents, advance directives, care plans, device manuals, DME instructions, or professional guidance.
Printable sheet versus digital YourEMR profile
A digital YourEMR profile can help when details change often. Keep the printed copy concise and use the digital profile or source records for fuller, updateable information.
The printable QR footer opens YourEMR free resources. It does not open the person's personal emergency profile.
Helpful terms
Advance directive: A legal document related to future health care wishes if someone cannot make decisions for themselves.
Health care proxy: A person named to make health care decisions if the person cannot, depending on the applicable document and law.
Document location: Where the current document or copy may be found, not a summary or interpretation of the document.
Directive Contacts details to record
Use short entries copied from current records, labels, cards, portals, folders, and trusted caregiver notes. Leave out anything that would be unsafe on a visible printed page.
Health care decision-maker contact, backup contact, family contacts, caregiver contacts, primary doctor, and facility or hospital contacts
Where advance directive, living will, health care proxy, POLST, MOLST, or other documents are kept if applicable
Which portal, binder, folder, facility file, or trusted person may have the current copy
A clear note that the sheet is a contact and location organizer only, not the legal document
Related YourEMR resources
Use these related YourEMR pages when they fit the person's situation.
These outside resources are for general education and preparedness only. Always follow emergency services, clinicians, pharmacists, insurers, official records, legal documents, device manuals, care plans, and professional guidance as applicable.
CDC preparedness guidance for organizing insurance cards, identification, medical records, emergency action plans, advance directives, care plans, and other important documents.
FEMA/Ready.gov planning form with household information, family members, emergency contacts, medical information, insurance information, assistive devices, and last-updated details.
Ready for an updateable profile?
Create a free account for emergency information that can change with your family.
YourEMR helps keep emergency information organized and ready when it matters.
These free sheets are informational organization tools only. They are not medical records, diagnosis tools, treatment plans, medical advice, or legal advice, and they do not replace 911, EMS, clinicians, medical records, medication labels, device manuals, care plans, patient portals, or professional guidance.
