Assisted Living
and Memory Care Forms
LIC 602A Physician’s Report
This required physician-completed form provides a comprehensive medical assessment of a senior’s physical health, cognitive status, functional abilities, and care needs. Assisted living communities use this information to determine whether they can safely and appropriately support the resident in a non-medical setting. Completing the LIC 602A helps prevent admission delays, ensures regulatory compliance, and supports a smooth and personalized assisted living placement process.
Medications and PRN Physician Approval Form
This form documents a resident’s routine and as-needed (PRN) medications and provides physician authorization for how and when they may be administered. It ensures that assisted living and memory care staff have clear, written instructions regarding medication dosages, routes, frequencies, and symptoms requiring PRN medications, helping promote safe, compliant, and appropriate medication management prior to and during admission.
POLST Physician Orders for Life-Sustaining Treatment
POLST (Physician Orders for Life-Sustaining Treatment) is a medical form designed for individuals with serious illness or advanced health conditions. It clearly outlines a person’s wishes for emergency medical care, such as resuscitation, hospitalization, and life-sustaining treatments, so health care providers know exactly how to act during a medical emergency.
This form is completed after a conversation with a doctor or medical provider and is signed by both the patient (or their legal decision-maker) and the provider. It helps ensure that care aligns with the individual’s values and preferences, while preventing treatments they may not want, especially in urgent situations
Advance Health Care Directive
This document allows an individual to plan ahead by designating a trusted person to make health care decisions on their behalf and by outlining their medical preferences if they are unable to communicate them. It helps ensure that future care decisions reflect the individual’s wishes, values, and priorities while providing guidance and peace of mind for family members and health care providers.
Caregiver Resources Flyer
This flyer provides a curated list of local and online resources to support caregivers of individuals with dementia or memory-related conditions. It highlights wellness tools, respite programs, support organizations, educational materials, and activity resources designed to help caregivers feel supported, informed, and better equipped in their caregiving journey.
Patriot Angels Brochure
This brochure provides an overview of how Patriot Angels helps eligible U.S. wartime Veterans and their spouses access Aid and Attendance pension benefits to help pay for senior living and care services. It explains eligibility requirements, potential monthly benefit amounts, and how Patriot Angels supports families through the application process, making this valuable benefit easier to understand and pursue.
Wartime Heroes Celebrated and Honored. We Thank You For Your Service!
As a wartime hero, you’ve earned the Aid and Attendance benefit through the U.S. Department of Veterans Affairs. Receive Veteran's Aid and Attendance application support from Patriot Angels. As a United States wartime Veteran or spouse, you can earn up to $3,071 a month TAX-FREE to help you pay for your Assisted Living or Memory Care.