Illness Injury and Emergency Planning

• Introduce new partners to the care network only with clear consent from all involved
• Share essential health information on a need to know basis and only with those who have explicit permission
• Provide new partners with a concise summary of the plan and their expected role
• Reassess and update documents periodically or after major health events

Templates and checklists you can adapt today

Emergency information sheet template

Full name: [Your Name]

Date of birth: [MM/DD/YYYY]

Primary contact: [Name] [Phone] [Email]

Emergency lead: [Name] [Phone]

Care circle members and roles: [Names and roles]

Medical conditions list: [Conditions]

Medications: [Medications]

Allergies: [Allergies]

Current physicians: [Doctor names and contacts]

Insurance details: [Insurance company policy numbers]

Medical decision maker: [Name] [Phone]

Privacy preferences: [Limits on sharing information]

Special instructions: [Any limitations or preferences]

Medical information consent sheet

I authorize the following people to receive medical information and to participate in decisions as described below:

• Emergency lead: [Name] allowed to receive information about emergencies
• Health information liaison: [Name] allowed to obtain medical updates from providers
• Care coordinators: [Names] allowed to assist with daily needs while respecting privacy
• Other permitted individuals: [Names with specific limits]

Purpose of sharing information: to ensure timely and appropriate medical care and support during emergencies.

Advance directive and care planning notes

My goals and preferences regarding medical care in situations where I cannot speak for myself are described below. If I regain capacity I would like to revisit these preferences with my care circle.

• Do you want life sustaining treatment considered in emergencies? [Yes / No / Limited set]
• Preferred hospital or medical facility: [Facility name]
• Preferred treatments or restrictions: [Details]
• Ongoing care priorities after recovery: [Details]

Disaster and travel planning card

A compact card that your emergency lead can carry or keep in a wallet. It lists the names of key care circle members and quick instructions for medical teams in emergencies when you are away from home.

Front side

Name Date of birth Emergency contact phone Emergency lead contact and authorization details

Back side

Care network members and roles Key medical facts Allergies Current medications

Glossary of useful terms and acronyms

• ENM Ethical non monogamy the practice of forming intimate relationships with the consent of all involved beyond a single monogamous framework.
• Non hierarchical polyamory a polyamory approach without a formal top level partner; multiple relationships are held in parallel with equal regard.
• Medical power of attorney a legal document naming someone to make medical decisions on your behalf if you cannot.
• Health care proxy another term for a person authorized to make medical decisions for you when you are incapable of doing so yourself.
• POLST a form that records specific medical treatment preferences for seriously ill patients.
• DNR do not resuscitate a directive that indicates whether CPR should be performed if your heart stops.
• HIPAA a privacy law protecting medical information in the United States; other countries have similar protections with different names.
• Care circle the group of partners friends and chosen family who participate in your health care and daily support during illness or injury.
• Advance directive a document that spells out your wishes for medical care in situations where you cannot communicate your decisions.
• Consent boundary agreed limits on what information can be shared and who can participate in decisions.

Frequently asked questions

Below are some common questions people have when building illness injury and emergency plans in a non hierarchical polyamory ENM network. If you have more questions add them to your plan and discuss with your care circle.

• How do I start planning for emergencies in an ENM network? Begin with a candid group conversation about values what kinds of emergencies you want to plan for and who should be involved in decision making. Then create basic documents and assign roles.
• What is the difference between a medical power of attorney and a health care proxy? In many places the two terms describe similar ideas. The important part is choosing someone you trust to make medical decisions if you cannot communicate your wishes and documenting that choice clearly.
• How do I protect privacy while sharing essential information with caregivers? Set clear consent boundaries and use role based access to information. Share only what is necessary for care and rely on legal documents to guide what can be shared and with whom.
• Who should be in the care circle if new partners join the network? New partners can be integrated after a discussion about privacy boundaries and consent. Update your information sheets and documents accordingly.
• What should I do if someone in the network disagrees with decisions? Return to the agreed care plan and values. Use a neutral facilitator to help mediate while keeping the patient’s preferences at the center.
• Do we need POLST or DNR forms for everyone? It depends on medical risk and personal preferences. Talk with a clinician about what is right for you and ensure forms are properly completed and stored with copies accessible to trusted caregivers.
• How do we handle emergencies when partners are traveling separately? Pre arrange emergency leads and share travel friendly copies of critical information. Use digital tools and offline cards so information remains accessible even without internet.
• How often should we review or update our plan? Check in at least annually and after any major health event or change in relationship structure. Update names roles and documents as needed.
• What if a partner refuses to participate in the care plan? Respect autonomy. Have an open discussion about why planning matters and how their involvement can protect the group. If necessary restructure roles to honor their boundaries while still protecting your health.
• Is written planning enough or should we see a lawyer? A written plan is a great start. If you have complex legal needs or unique jurisdictional requirements consult a lawyer who understands ENM family dynamics and durable powers of attorney.