Caregiver and Family Helper Permission Organizer

A helper should use only the information needed and respect the disabled person’s choices and lawful authority.

Use exact wording when you have it. You may skip this question and return later.

Use exact wording when you have it. You may skip this question and return later.

Use exact wording when you have it. You may skip this question and return later.

Use exact wording when you have it. You may skip this question and return later.

Use exact wording when you have it. You may skip this question and return later.

Copy dates and instructions exactly from the complete notice, plan, policy, decision, or other source. Do not rely on this organizer to calculate a deadline.

Include the document name, page or line, exact quote, and anything that still needs to be checked.

List questions for an official source, benefits counselor, accredited representative, lawyer, or other qualified professional.

Write small, specific actions such as checking an official source, requesting a record, calling a benefits counselor, or finding qualified help. Verify any time limit separately.