Below are three forms designed to help you create your own care plan. You might choose to use one form – or all three. These forms were developed in collaboration with teens that have ongoing health needs. We tried to make these care plans as flexible as possible. You can use or change the forms to best meet your needs.

View a sample care plan

If this is your first time filling out a care plan, it may help you to work through these together with your parents and doctor.

  • What’s the Plan?
    Designed to help you organize your questions and concerns. Helps plan for doctor visits and includes space for writing down “next steps.”
    View a completed sample document.
  • In Case of Emergency
    Provides information that would be critical to people caring for you in an emergency. It is designed so that you can carry it with you at all times in your wallet.
    View a completed sample document.

Next steps:
Think of people that you would like to share your care plan with. These may be people that help take care of your health or people that may need to know about your health. They could include doctors, nurses, therapists, teachers, coaches, friends, grandparents or neighbors.

Good luck!

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