Wallet  Card

for the South Carolina Health Care Power if Attorney and the Addendum:  Statement of desires regarding mental health treatment and care

Cut out, fold in the middle and complete the card below.  Place the card in the wallet or purse you carry most often, along with other forms of identification.

Cut here, fold and tape edges together. 
                   

  + + + Medical Alert + + +

    Attention health care providers, physicians, and others

I have created the following Health Care Directives:
         Health Care Power of Attorney
         Psychiatric Advance Directive
 A copy has been placed in my medical records located at:
                                                                                         
                                                                                                                   (see other side)

 + + + Medical Alert + + +

If I am incapacitated, please obtain my Health Care Directives document and respect the choices I have registered in it.

In the event I an incapable of making health care decisions, I may have appointed an agent/proxy.

Name of agent/proxy:                                                   
at                               (day)                            (evening)
My name:                                                                        
My SS#                                                                            

 

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