BMW R1200R R1150R/T F800 K1200R R1100R/T R1250R RnineT Message Board

Forum Members,
I have a couple of forms that would be very useful in case those of us who tour were to get into some serious physical damage. They are in doc format and I have attached them.

At the hospital where I work are medical forms that I realized only a couple of weeks ago would be quite helpful in case of an accident. And, they are organized, having most of the medical information that anyone taking care of a severely injured non responsive rider would want. That is the "history" form--please note that all current medications should be listed on the rear side of the sheet. It would be a good idea to include the dosage regimen and the reason for taking.

The other form is a "Living Will." It is self explanatory. I don't know how well they cross state lines, but if I were the treating MD and I saw this it would influence me in my care.

Both should be current and carried on your person--where a first responder would find it.

I hope we never ever need it

John

history form http://www.r1150r.net/history.doc
living will http://www.r1150r.net/livingwill.doc

Great info...

"Living Will", Medical Power of Attorney, Medical History, and ICE (In Case of Emergency) contact data are useful. The problem across state lines bears further research.

Here is some more info (footnotes excluded)...

Advance health care directives or advance directives are instructions given by an individual specifying what should be done for his or her health in case he or she is no longer able to make decisions. A living will is one type of advance directive. It is often accompanied by a specific type of power of attorney or health care proxy. These are legal instruments that are usually witnessed or notarized. It is often encouraged that people complete both documents to provide the most comprehensive guidance regarding their care.[1] Studies have also shown that adults are more likely to complete documents written in everyday language.[2] One example of a combination document written in everyday language is the Five Wishes advance directive.

A living will usually covers specific directives as to the course of treatment that is to be taken by caregivers, or, in particular, in some cases forbidding treatment and sometimes also food and water, should the principal be unable to give informed consent ("individual health care instruction") due to incapacity.
A power of attorney for health care appoints an individual (a proxy) to direct health care decisions should the principal be unable to do so.

In the United States, most states recognize living wills or the designation of a health care proxy.[4] For example California does not recognize a living will but instead uses an Advanced Health Care Directive. [5] However, a "report card" issued by the Robert Wood Johnson Foundation in 2002 concluded that only seven states deserved an "A" for meeting the standards of the model Uniform Rights of the Terminally Ill Act.[6] Surveys show that one-third of Americans say they've had to make decisions about end-of-life care for a loved one.[7]

Just making this a sticky for a day so people see it..

I would suggest checking with an attorney in your respective states. Louisiana, for example, has a statutory form version of the living will called "Declaration concerning life sustaining procedures".

It is a good rule of thumb, that if a legislature has enacted a specific form, you better use it to avoid having a "Florida" situation.


Doug
(Lawyer)

ka5ysy wrote:I would suggest checking with an attorney in your respective states. Louisiana, for example, has a statutory form version of the living will called "Declaration concerning life sustaining procedures".

It is a good rule of thumb, that if a legislature has enacted a specific form, you better use it to avoid having a "Florida" situation.


Doug
(Lawyer)

Hi, Doug,
That form is being used in our hospital as a living will. We are in Covington, La. It is my understanding that it passes Louisiana legal muster. I have worked at a few hosptials in south La. No two had the exact same living will. If you have specific information re La law, please share with me in a PM. My search only uncovers "examples" of a living will, of which the linked form is one. Most riders are not going to contact an attorney for such information.

My point in posting these two medically important forms is to help riders with detailing specific medical information that would be helpful in their treatment should a serious injury befall them.

The form that would have much more day to day usefulness is the medical history form. The living will form would give a provider and the rider pause to decide on these possibly life sustaining procedures. In all cases notification of next of kin is attempted, no matter what.

John
(mortal)

For those interested, here is the Louisiana form and a note after it about verbage that needs to be in a Power of Attorney document. Actually we all should have a durable power of attorney in addition to the living will in order to meet legal requirements and to have a medical power of attorney in addition:

Here is the Louisiana form;

DECLARATION CONCERNING LIFE SUSTAINING PROCEDURES
(LIVING WILL)
La. R.S. 40:1299.58.3 (2007)
STATE OF LOUISIANA
PARISH OF EAST BATON ROUGE

DECLARATION made on this ____________ DAY OF ______________, 200_____ by


I, ________________________________________________________, being of sound mind, willfully and voluntarily make known my desire that my dying shall not be artificially prolonged under the circum¬stances set forth below and do hereby declare:

If at any time I should have an incurable injury, disease or illness, or be in a continual profound comatose state with no reasonable chance of recovery, certified to be a terminal and irreversible condition by two physicians who have personally examined me, one of whom shall be my attending physician, and the physicians have determined that my death will occur whether or not life-sustaining procedures are utilized and where the application of life-sustaining procedure would serve only to prolong artificially the dying process, I direct:

(INITIAL ONE ONLY, A OR B):

____________A. That all life-sustaining procedures, including nutrition and hydration, be withheld or withdrawn so that food and water will not be administered invasively.

____________B. That life-sustaining procedures, except nutrition and hydration, be withheld or withdrawn so that food and water can be administered invasively.

I further direct that I be permitted to die naturally with only the administration of medication or the performance of any medical procedure deemed necessary to provide me with comfort care.

In the absence of my ability to give directions regarding the use of such life-sustaining procedures, it is my intention that this declaration shall be honored by my family and physicians as the final expression of my le¬gal right to refuse medical or surgical treatment and I accept the conse¬quences from such refusal.

I fully understand the import of this declaration and I am emotionally and mentally compe¬tent to make this declaration.

SIGNED:

______________________________________________


DATE SIGNED: _________________________________


The above and foregoing declaration has been signed by the declarant in our presence and the presence of the undersigned witnesses declare that they believe the declarant to be of sound mind and is making a knowing and informed decision in exe¬cution of this declara¬tion.

WITNESSES:

_______________________________________

_______________________________________




============================ SNIP===========================

The other thing that needs to be done is to have a power of attorney containing the following wording or something like it to make a durable power of attorney that also meets the HIPAA requirements:


Appearer further declares that it the appearer' specific intention that this shall be a durable power of attorney and shall continue and be in full force and effect in the event of appearer's illness or incompetency for any reason; and in the event that any proceedings are instituted by anyone to interdict appearer for any reason, then appearer specifically directs that appearer's said agent and Attorney in Fact be named to represent the appearer as curator or curatrix, in the event an interdiction should be decreed, it being appearer's intention that this Power of Attorney is to be in full force and effect until appearer's death, unless previously revoked by appearer by Authentic Notarial Act.

It is further the appearer’s intent that this power of attorney shall include a medical power of attorney for purposes of determination of medical treatment decisions should appearer be unable to act in his or her own behalf, and all medical facilities and personnel are hereby directed to disclose any and all information to my agent in order for the agent to act under this medical power of attorney, and this authority is specifically granted to meet the requirements of Standards for Privacy of individually Identifiable Health Information under the Health Insurance Portability and Accountability Act (HIPAA), 45 CFR 160 and 164.









Hope this helps 1

Doug

Interesting and helpful subject! I have been to Mexico on an extended tour and plan to go again this winter(BTW,looking for a riding partner for a Jan /09 trip?,4-5 weeks), so , having bought a medical plan that covers international travel in the past, I am curious if there is an available set of forms , in spanish, that I could carry? I cannot look for them on the web, as my spanish is laughable.
As a side note, I ended up with a Mexican truck driver (that had lived in NC for 8 years) helping me find a clinic to get my road weary,stiff neck repaired.Without language skills, the medical issue looms large down there-and here to , I suppose.Any thoughts out there?

good luck with the trip. I don't know if I would use a living will down there

But the medical history form---
many medical words in both English and Spanish have the same Latin or Greek roots so they may be decipherable.

If you wanted a bare bones form I would include
allergies

cardiac health

Pulmonary, esp do you have asthma

liver--esp hepatitis

Diabetes info

and then a list of your medicines, use the generic names__the ones in parentheses_ and include the dosage

that would be the basics--then after that surgical history, family conditions, the other stuff

check this out http://www.migrantclinician.org/_files/ ... 267d55a336

definitely add your allergies--they can kill you as fast as anything

John

post whenever you can doctor, and stay safe.

Whoops wrong topic.

My experience in Mexico at the clinic was a positive one, but caused me to think how helpless you might feel in a more critical situation . Staying on top of medical situations has been brought home to me(a non-medical person) by personal experience(hey doc I'll tell you some good ones at a rally some time for a cold one!) with self ,Mother and my wifes uncle, all involving care decisions or improper care, or lack thereof! I was led into the clinic by this truck driver(I followed his 18 wheeler for 25-30kafter talking to him at a police stop, re,do they have Chiropractors in Mexico to fix bad neck?)in his home town and he did the preliminaries and I end up with this young guy that I think is a doctor but turns out to be some sort of a nurses aide level worker and he takes me to a row of cubicles that each have a bench with pad/sheets/pillow and says to wait and that she will be there in a momento. Well, "she" walks in and is this beautiful Mexican girl in a white coat with a bunch of stuff embroidered on her coat that I cannot read(doctor,lawyer,Indian chief?) and is obviously blind.Understand that at this point I have not a clue what is going to happen next other than everybody seems really nice.The aide guy senses my concern( he speaks a little english) about what is going on and tells me"she" ,"is very good with the hands"!I will ad, that "she " is also obviously blind. It turns out to be one of the alltime best massage sessions I've ever had, and I was a college athlete that had more than a few of them.She focused on my neck and upper back/shoulder muscles and WOW, I felt ready for some more Mexican roads! This "clinic" had a bronze statue outside that was evidently the old lady who was the benefactor that gets credit for the clinic. I was refused to pay a dime for their services. The moral of the story might be, you never know when you might run into one of the Mexicans here in the states again, but be assured that they are one especially nice bunch of people!There is a lot of bad press surrounding illegals and it needs some balance.

Thanks for the distraction!

What I meant about the living will and foreign travel was that it is something you want to be read EXACTLY as you mean it, not finding someone who speaks a little English.

Where in Mexico is this blind vision with the million dollar hands?

The clinic town is Pachuca-is below Mexico City by a bit. The truck driver had saved his money for the 8 years he was in NC and bought his own rig. A nice little success story he represents. Had his wife riding with him as school was out and the gma was sitting for them. He said he sometimes comes back to USA when hauling produce north. There are many Mexicans that really love their country and don't want to stay in the USA, in fact I talked to lots that said"I love Mexico" and at times this was being stated in a solid waste nightmare area. Come along for a trip...