A white background with a yellow and blue BEAM logo at the top left with the words “Black Emotional and Mental Health Collective” underneath. Blue text at the top right with the words “COMMUNITY CARE SUPPORT PLAN.” Black text underneath says, “The Community Care Support Plan is a tool to help us take care of each other. It can be used to support someone who is in distress, to maintain access needs or continue every day care.

Once completed, the document can be shared via taking a photo, emailing or paper copy to help ensure all those supporting someone can coordinate and have the same information.”

On the page, there are six hexagons organized into a circle. Starting from the top center and going clockwise:

1 - “Family/Friends/Closest of kin to call in case of an emergency.” Space to fill in an Emergency Contact.

2 - “Meals & Food Prep Support Team.” Space to fill in allergies and food restrictions.

3 - “Medication Reminder Support Team.” Space to fill in current medications for doctors to know.

4 - “Doctors, Therapists, Community Resources.” Space to fill in insurance information.

5 - “Check in Support Team.” Space to fill in who will do call check in’s and who will do home check in’s.

6 - “Child & Pet Care Support Team.” Space to fill in child/pet allergies & food restrictions, child/pet doctors numbers or clinics, and insurance information.

At the center of the circle of hexagons is space to fill in “Community Care Support Plan For: _________.”

At the bottom in blue text says, “2018 Copyright BEAM (Black Emotional and Mental Health Collective)”