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BEING WITH DYING APPLICATION
The Project on Being With Dying
Training for Health Care and Community Educators
CHECKLIST FOR PARTICIPANTS
1) Fill out application completely, and send back to Pay Zen
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How to fill out being with dying application

How to fill out a being with dying application:
01
Begin by carefully reading through the application form to ensure that you understand all the requirements and questions.
02
Collect all the necessary documents and information that will be needed to complete the application, such as personal identification details, medical history, and any supporting documents related to the individual's condition.
03
Fill in your personal details accurately, including your name, address, contact information, and any relevant legal or guardianship information, if applicable.
04
Provide a detailed explanation regarding the individual's condition and the reasons for seeking being with dying assistance, ensuring that you answer all the questions and provide any necessary medical documentation or reports.
05
If required, include any supporting documents, such as letters from healthcare professionals, medical records, or legal documents, to provide further evidence of the individual's condition and their desire to receive end-of-life assistance.
06
Review the completed application form thoroughly to double-check for any errors or missing information. Make sure that all sections and questions have been answered appropriately.
07
Sign and date the application form in the designated areas, ensuring that you are authorized to do so if applying on behalf of someone else.
08
Submit the application form and any accompanying documentation by the specified method, such as mailing it to the relevant organization or submitting it online through their designated platform.
Who needs being with dying application:
01
Individuals who are suffering from a terminal illness or are in a critical condition and have made the decision to seek end-of-life assistance.
02
Family members or loved ones who are acting as caregivers or advocates for the individual and are responsible for completing the application on their behalf.
03
Healthcare professionals or organizations who provide being with dying services and require the application to assess the eligibility and suitability of the individual for their program or assistance.
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What is being with dying application?
Being with dying application is a legal document that allows an individual to express their end-of-life wishes and preferences for medical treatment.
Who is required to file being with dying application?
Any individual who wants to ensure their end-of-life wishes are followed should file a being with dying application.
How to fill out being with dying application?
To fill out a being with dying application, you need to discuss your wishes with your healthcare provider and complete the necessary forms.
What is the purpose of being with dying application?
The purpose of being with dying application is to provide guidance to healthcare providers and family members about an individual's end-of-life preferences.
What information must be reported on being with dying application?
Information such as preferred medical treatments, resuscitation preferences, and organ donation wishes should be reported on a being with dying application.
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