Adult and Supportive Person Care Planning Tool Kit
Make a plan with the help of a supportive person using words and pictures to show your care choices and preferences.
Starting at 18 years old, you can make your own health care choices. You can choose a trusted supportive person to help you write down and show your care choices in a Personal Care Plan. Your supportive person can be a family member, a friend, a caregiver, a care professional, or anyone you like. Your supportive person can help:
- Give you information in ways you can understand in order to make care choices;
- Fill out a Personal Care Plan to show your care choices using words and pictures;
- Talk with your doctors and care teams about the care and services that are right for you.
Making a Personal Care Plan helps your doctors, care teams and other important people know the kind of care you need and want to receive, today and everyday over your lifetime.
Who Can Use This Tool Kit
Any person 18 years and older who can choose a supportive person can use this tool kit. It is designed for adults with a range of abilities. Adults who have the ability to make some or all care decisions or can indicate their personal preferences using words and pictures can make a plan with the help of a supportive person. The adult and supportive person can review the 3-step guide and help fill out the Personal Care Plan to show the adult's choices and personal preferences and attach planning documents. See instructions below.
How to Use This Tool Kit
The Personal Care Plan is personal document, not a legal or medical document. You can fill it out in any way that is best for you. You and your supportive person can download and print the tool kit (PDF) and fill out the paper document, or make your own digital document, using a computer, electronic device or any technological aids. You can use words and "copy and paste" in pictures and icons to show your care choices and personal preferences. When complete, print a copy and attach planning documents in Step 2 and any other information you like. Give a copy to important people to know and honor the kind of care you need and want.
Here Are Two Suggestions
1. Make a Paper Document. No computer needed.
- Download the tool kit (PDF) and print a paper copy.
- In Steps 1, 2 and 3, check the appropriate boxes by hand.
- On the Personal Care Plan page, fill in your name and supportive person's name.
- On the My Personal Directive pages, consider each section. Use words to write in your preferences or cut out small pictures and paste on the paper copy or use a combination of both.
- On the My Planning Documents and Signature page, check the appropriate boxes and attach completed documents and any other information you like. Sign the document.
2. Make a Digital Document. Adapt the tool kit using a computer, laptop, electronic device or technological aids.
- Start with a google document or word document or electronic/digital document of your choice.
- Copy or duplicate the tool kit on the digital document or technological aid.
- In Steps 1, 2 and 3, check the appropriate boxes in the checklists.
- On the Personal Care Plan page; fill in your name and supportive person's name.
- On My Personal Directive pages; copy, paste and resize small pictures, icons, emojis and use text where needed in the six sections.
- On the My Planning Document and Signature page, check the appropriate boxes and attach completed documents and any other information you like. Sign the document.
- Download the tool kit (PDF) and work in Free Adobe Acrobat or another PDF program.
- Using the fillable PDF, check the appropriate boxes in the Steps 1-2-3 checklists.
- On the Personal Care Plan page; fill in your name and supportive person's name.
- On the My Personal Directive pages, consider each section. Add small images, icons, or emojis under the six section headings. Add text where needed to indicate care preferences.
- On My Planning Documents page, check the fillable boxes and attach completed documents and any other information you like. Sign the document.