will need this information to properly treat you. If you've had an
accident or are unconscious, you may not recall, or state this
information. Once you have composed this document, give a copy to every
MD that you see, for your file. Also, provide a copy to your local
hospital's Medical Records, for their file on you. Update as needed.
Doing this may save your life. This document is stored on diskette as
plain text, and is printed with half inch borders, header and footer.
Feel free to forward.
(Diskette file name) YOUR FULL NAME PERSONAL MEDICAL INFORMATION.
Updated:
MM-DD-YYYY, PAGE 1 OF 1.
01. I AM: Full Name, Street, City, State, ZIP; (H) Home Phone; (O)
Office Phone; (C) Cell Phone; Gender: ......; Birth Date:
MM-DD-YYYY; Blood Type: ..........; Religion: ..........
02. EMERGENCY CONTACT: Full Name; Street; City; State; ZIP; (H)
Home Phone; (O) Office Phone; (C) Cell Phone.
03. HEALTHCARE PROXY AND LIVING WILL LOCATIONS AND PROHIBITIONS,
INCLUDING 02. EMERGENCY CONTACT, MDs AND HOSPITAL FILES.
04. PRIMARY CARE PHYSICIAN: Dr. Full Name; Office Street; City;
State; ZIP; (O) Office Phone; If Available: (C) Cell Phone; (H) Home
Phone.
05. First Specialist: TITLE: Contact Info. such as 04. PCP.
06. Second Specialist: TITLE: Contact Info. such as 04. PCP.
07. ALLERGIES: Alphabetized.
08. MEDICAL HISTORY:
........Alphabetized Medical Condition.
Medical Condition 1.
Medical Condition 2.
Etc.
09. DAILY PRESCRIPTIONS:
........Alphabetized.
10. OTC - PER DAY:
........Alphabetized: B-12 (Dose); C (Dose); Etc.
AS NEEDED: ........Alphabetized.
____________________________________________________________
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Information here in is for educational purpose only; it may be news related,
speculation or opinion. Consult with a qualified MD before deciding on any course of treatment, especially for serious or life-threatening illnesses.
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