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Cover Sheet - OSF HealthCare - osfhealthcare 2026

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The document is a cover sheet for a Power of Attorney for Health Care form and Patient and Family Discussion Record, which includes sections for the principal's information, health care agent details, and distribution of copies to family, friends, and medical professionals.

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Click ‘Get Form’ to open the Cover Sheet in the editor.
Begin by entering the Principal (Patient) Information. Fill in the patient's name, date of birth, address, and telephone numbers for daytime, nighttime, and cellular contact.
Next, provide details for the Health Care Agent. Enter the name of the Power of Attorney for Healthcare along with their daytime, nighttime, and cellular telephone numbers.
If applicable, fill in information for a Successor Agent by providing their name and contact numbers as well.
Complete the section for copies of this Advance Directives Cover Sheet. List names and addresses of family/friends/pastors and physicians/specialists/hospitals who should receive copies.
Finally, indicate dates for original and revised documents as necessary.

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