Helper role Adult child Spouse or partner Friend or neighbor Paid caregiver or agency worker Long-distance helper
Main setting to prepare for Primary care or specialist visits Hospital, rehab, or discharge follow-up Medicare, plan, or claims questions Pharmacy, refills, or medicine pickup Several settings
Current permission status Not started Only verbal permission so far Some forms or releases done Unclear or conflicting Organized and current
Medicare or plan contact Not needed yet Call may be needed soon Appeal, grievance, claim, or coverage request Not sure who to call
Patient portal setup Not set up Shared password is being used Proxy or caregiver access exists Paper or phone only
Pharmacy support needed Refills or pickup Delivery or refill synchronization Cost, coverage, or prior authorization Not involved with pharmacy yet
Appointment access pattern Helper attends visits Helper joins by phone or video Helper calls after the visit Older adult usually attends alone
Records or follow-up need After-visit summaries Test results or referrals Discharge papers Formal medical records request
Decision authority status Not sure No known decision-helper document Health care proxy or advance directive POA, guardian, or similar authority
Privacy plan Needs a privacy plan Updates shared with family Paid helper needs limited information Clear and organized
Use this before care coordination gets urgent.
Do not enter diagnoses, Medicare numbers, Social Security numbers, claim numbers, medication names, portal passwords, or private records here. Use the result to prepare questions for clinics, Medicare, plans, pharmacies, and qualified professionals.
This planner is educational and organizational only. Permission to receive information is not the same as authority to make decisions, sign forms, appeal denials, manage benefits, or consent to treatment.
Official references:
HHS HIPAA family and friends ,
HHS HIPAA disclosure FAQs ,
Medicare talking with a doctor ,
CMS Medicare information release ,
CMS appointment of representative .
