In addition to basic medical information and emergency contact numbers, this form contains suggestions on how best to facilitate communication when there are hearing, vision, speech or memory problems that make it difficult to provide all the needed information.
In an emergency situation, every minute counts and access to updated medical information can save not only time but lives.
1. Complete a form for yourself and have every member of your household complete one. It is important to have a contact person who is nearby in case you are taken to the hospital and you have a loved one who cannot be left alone or pets you are responsible for.
2. If someone is having difficulty filling in the information, please assist them. In the case of visual limitations, you may need to make a copy that has larger print. Complete the information in pencil so that it can be updated more easily.
3. Complete as much of the information as possible. If a question does not apply, please write N/A (not applicable).
4. Since medication lists are not always updated, we strongly urge you to keep your CURRENT medications in one place so emergency personnel can access them easily. The actual pill bottles will contain essential information. Information about non-prescription medications or vitamins and supplements you are taking will be equally as important.
NOTE: If you update your medications EVERY time they are changed, you may want to keep a card inside your packet with that information. ALWAYS include the date when your list was last updated.
5. Important medical history should be included. If there is additional information you feel is important and not covered on the form, place it in the packet with your VITAL HEALTH RECORDS.
6. The second page has information about communication and is primarily a checklist. If you want to include additional information that might be helpful, use the lines provided at the end of the appropriate section.
7. You may want to make an extra copy of your completed form. Emergency responders may choose to take this information with them when transporting you to the hospital. You may want to keep an extra copy in the glove compartment of your car. If you decide to take a copy to your doctor's appointment, make sure you update it if necessary and return it to the packet containing your VITAL HEALTH RECORDS.
8. Place the VITAL HEALTH RECORDS information inside the plastic packet. Place the sticky side of the fastening tape on the back of the packet on the place indicated and affix the packet to the inside right wall of the refrigerator below the level of the first shelf. In some communities, emergency responders may not look for the form. It would be helpful if you could make them aware of the form upon their arrival at your residence.
9. REMEMBER it is very important to update your VITAL HEALTH RECORDS periodically - especially when a change occurs. Misinformation can delay your ability to get the appropriate intervention in a timely manner.
If there are no changes, review your VITAL HEALTH RECORDS at least twice a year to make sure the information is current. A good time to do this is when you reset the clocks and check your smoke detector batteries twice a year.
VITAL HEALTH RECORDS.
