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Health Forms

Medication List

Download and Complete a Medication List

Take an active role in managing your medications by carrying a medication list. Medication lists help reduce the risk of:

  • Improper dosing
  • Duplicating medications
  • Harmful drug interactions
  • Side effects

Download and complete your medication list, carry it with you, and share it with your health care providers at every visit. It may save your life!

View Providence retail and outpatient pharmacy locations.

Advance Directives

Five Wishes® advance directive document helps you let your doctor, family and friends understand your wishes

RMC_Five_WishesNo matter your current age or health, by the time you become seriously ill, you may be unable to make and express decisions about the way you want to be treated when the end of your life is near.

That’s why Aging with Dignity, a national non-profit organization, developed Five Wishes, an easy-to-use document in which you fill in the blanks to make your wishes known.

Five Wishes meets health decision statutes in Washington state and is also a form of “advance directive.” It includes five sections that outline specific directions for how you want to be treated. You simply fill it out and then share it with your doctor and family members.

  • Wish One lets you choose the person you want to make decisions for you when you can’t make them for yourself. (This is known as “durable power of attorney for health care.”)
  • Wish Two is a living will. It lets you put in writing the kind of medical treatment you want or don’t want if you become seriously ill and can’t communicate.
  • Wishes Three and Four let you describe in detail how you want to be treated so that your dignity can be maintained.
  • Wish Five gives you a chance to tell others how you want to be remembered and express other things that might be in your heart, such as forgiveness.

Order Your Copy of Five Wishes Today

Make sure your wishes are known. Order your copy of Five Wishes for $1 from the Spiritual Care department at Providence Regional Medical Center Everett. For more information contact Ann Gibson at (425) 261-4550.

Source: Aging with Dignity