Working...
This site is intended for US Consumers

Health Journey Support | Health Emergency Information Plan

It is important to have your health information available in the case of a health emergency. This brochure can be printed and filled out so that you a list of your medications, medicines you are allergic to, your health conditions, your doctor's contact information, and the person(s) to contact in the case of an emergency, should you have to go into the hospital.

Keyword must be at least 2 characters long You must enter a keyword(s) to search

If you are a health care professional affiliated with an employer, institution, or committee, or practicing in a state that restricts what items you may receive from manufacturers, we ask that you not accept or download any restricted items from this site. If you are a health care provider practicing in Vermont, we are required by state law to deny you permission to download any items or review any journal articles made available on this site.

Select language for viewing, sharing, and downloading

THIS INFORMATION IS INTENDED FOR US CONSUMERS

Health Emergency Information Plan

Fill out the form below and make several copies. Keep one copy near your home phone, where you can easily see it. Keep another copy at work, and a third copy in your wallet or purse.

Information to share with emergency medical personnel and hospital staff

Medicines you are taking (and dosage strength, if possible):

















Medicines you are allergic to:











How to contact your doctor

If symptoms stop completely in less than 5 minutes, you should still call your doctor right away.

Doctor's name:


Type of doctor:


Phone number (office hours):


(after office hours):


Other doctors you are seeing and why:







What you have been diagnosed with:











Person to contact if you go to the hospital

Name:


Home phone number:


Mobile phone number:


Source: National Heart, Lung, and Blood Institute. National Institutes of Health, US Department of Health and Human Services.

Talk to your doctor

Always talk to your doctor about what is best for you. Ask your doctor before starting any treatments or making changes in your routine or medicine.