Important Contacts and Write-In Numbers
Fill this out before a crisis if possible. Cross out old numbers and date corrections.
Person receiving care ____________________________________________
Facility / clinic / agency ____________________________________________
Room / unit ____________________________________________
Nurse / charge nurse ____________________________________________
Doctor / primary care ____________________________________________
Administrator / supervisor ____________________________________________
Social worker / case manager ____________________________________________
Pharmacy ____________________________________________
Main family contact ____________________________________________
Backup family contact ____________________________________________
Health-care agent / POA ____________________________________________
Tribal / cultural / spiritual support ____________________________________________
Ombudsman / advocate ____________________________________________
APS / regulator ____________________________________________
Transportation ____________________________________________
Insurance / coverage ____________________________________________
Veterans helper / CVSO ____________________________________________
Other ____________________________________________
Keep this page updated. Put the most reliable number first. Add the date next to a new number. Reprint this page after a move, hospitalization, new diagnosis, new facility, death, or change in family authority.
Web version of a self-contained tear-out from Family Care Navigation Packet · Institute Public v2.3.0. Contacts in the controlled packet were last verified July 31, 2026; confirm changing details before acting.