Steps Following the Death of a Loved OneIowa Attorney ... 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name in the 'Name of Client' field. This identifies you as the individual requesting the designation.
3. Fill in the 'Date of Request' to indicate when you are completing this form.
4. Provide your mailing address, including street or P.O. Box, city, state, and zip code for correspondence.
5. Enter your Social Security Number, Patient Number, or State ID for identification purposes.
6. Input your phone number so that you can be contacted if necessary.
7. Check all applicable programs such as Medicaid or Hawki that relate to your situation.
8. Specify your birth date and facility information if relevant.
9. Designate a personal representative by writing their name in the designated field and indicating their relationship to you (e.g., child, spouse).
10. Finally, sign and date the form at the bottom to validate your request.

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