Emergency Health Information Card

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Put these items on the front:

  • Name
  • Street Address
  • City, State, Zip
  • Phone (Home, Work)
  • Fax No
  • Birth date
  • Blood Type
  • Social Security No.
  • Health Insurance Carrier and Individual and Group #
  • Physicians

Put these items on the back:

  • Emergency Contacts
  • Conditions, Disability
  • Medications
    • If you take medication that cannot be interrupted without serious consequences, make sure this is stated clearly and include:
      prescriptions: dosage, times taken other details
  • Instructions: i.e.: take my gamma globulin from the freezer, take my insulin from the refrigerator.
  • Name, address, phone and fax numbers of pharmacy where you get your prescriptions filled.
  • Assistance Needed
  • Allergies
  • Immunization Dates
  • Communication/Equipment/Other Needs