Elder Care Authorization

I, the undersigned Dorian Mayhew Rothschild, hereby grant: Samantha Bricker (the "Caretaker), 35 Palm Circle Dr. Corte Madera, CA 95422 4157745543 / 4157745543 (alternate) sbricker@dhas.com the authority to take temporary care of the following adult: Reginald Rothschild. This grant of temporary authorization to provide elder care shall begin on April 24, 2012, and shall remain effective until terminated by the undersigned. The Caretaker shall have the power to: - Administer medications as follows: Name of medication: Sandrillo Amount to be given: 1 pill Time to be given: 12:00 PM Name of medication: Heptex Amount to be given: 2 pills Time to be given: every four hours - Seek appropriate medical treatment or attention on behalf of Reggie Rothschild as may be required by the circumstances, including but not limited to, medical doctor and/or hospital visits. - Authorize medical treatment or medical procedures in an emergency situation. In an emergency situation, please contact the following person: Name: Address: Dorian Mayhew Rothschild 60 Arthur St. San Rafael, CA 94901 Phone Number: 4158432331 Alternate Phone: 4158249956 Email Address: droth@sloth.com If that person is not available, please contact the following alternate choice:
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Name: Address:

David Rothschild 123 Main St. Mill Valley, CA 94941 Phone Number: 4154431234 Alternate Phone: 4154431234 Email Address: daveroth@russ.co.uk

Dated: April 24, 2012

______________________________________ Dorian Mayhew Rothschild, Adult Son 60 Arthur St. San Rafael, CA 94901 4159951234 / 4154754453 (alternate) droth@sloth.com

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