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In the OLOC Reporter there was an article about Alapine (a Lesbian community) in Alabama. The Community holds monthly meetings to discuss end of life matters. These issues are covered in a 40 page booklet from http://www.critical-conditions.org or phone 1-877-633-2433. There is a $15 fee for the booklet.

Alpapine members are asked to complete the book and receive a yearly reminder to update it.

Alpine members created a form containing the information requested by paramedics. Members post the forms on the refrigerator along with other places that the form can be quickly retrieved in case of an emergency.

Here is a copy of the Alapine form in case you want to use it or create something like it yourself. Be careful where you store it as it would be pretty easy for someone to commit identity theft if they accidentally came across it.

Below is the link to the free form.


Permanent link to this article: http://oloc.org/resources-2/alapine/


Name: __________________________________________________As of Date:________ Address: _________________________________________________________________ Phone(s) _________________________________________________________________ Email address: _______________________________ Born: Date: ______________ Where: _______________________ Age: _______ Sex: ______________________ Race: ____________ Hair Color: _______________ Medical Height: _____ Weight: ______ Eyes    Blind: ______ Glasses: ______Contacts: _____ Mouth   Dentures: __________  Other Problems: ______________________________ Ears    Mute: ________ Deaf: _______ Hearing Aid: ________ Sign Language_________ …

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