Assisted Living 
 in Maryland
Info (at) PleasantGarden (dot) org410-300-4443  / 410-870-0758


Health Care Practitioner Physical Assessment form

Health Care Practitioner Physical Assessment form. This form, signed by the resident's primary care physician (PCP), contains a brief medical history and diagnosis. The last pages contain a list of current medications, which should also be signed by your PCP
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MOLST (aka Medical Orders for Life-Sustaining Treatment)

MOLST (aka Medical Orders for Life-Sustaining Treatment). This form is specific to Maryland and is like an Advance Directive, but on a form that we must have on file. Filled out by your PCP, in consultation with the resident or resident representative, it shows basic end-of-life wishes for the resident that first-responders need in an emergency.
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Copy of Social Security card
 Copy of Medicare card (if applicable)

 Copy of Medicaid card (if applicable)
Copy of Maryland driver’s license or Maryland ID or other picture ID
Copy of other insurance card
Copy of Power of Attorney (POA) (if applicable)
Copy of Guardianship documents (if applicable)
Burial Arrangements (In event of untimely resident death. If resident or family fails to fill out Burial Arrangements, remains will be referred to the State Anatomy Board of Maryland, 655 W. Baltimore St, Baltimore, MD 21201; (410) 547-1222.)
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