Refrigerator Card
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Providing emergency personnel with critical information could be the difference between life and death.  Print out this page, fill in the information and post it on your refrigerator.

Name:  
Date Card Completed:  
Address:  
   
Telephone#:  
Allergies to Meds:  
   
   
Whom to Contact Name & Phone #: 1.
  2.
Date of Birth:  
Social Security #:  
Doctor’s Name:  
Doctor’s Phone:  
Major Illness:  
   
Other:  
   
Health Care Plan:  
Medicare#:  
Ambulance Service:  
Preferred Hospital:  
 
MEDICATIONS
 
 
 
 
 
 
Last Updated: Sat Aug 19 03:32:43 EDT 2006
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