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Medical Information Form
   
     
    Introduction to Medical Information Form
    What the Medical Information Form Looks Like
    How to Download
    How to Fill Out
  How to Use
    How to Print
 
How to Use the Medical Information Form™

1. Take a copy of the updated form with you whenever you leave your home and  know where your latest version is at all times.

2. Keep a copy in your wallet or backpack.

3. If you live alone have a copy near the most noticeable phone in your home.

4. Have your doctor's staff make a copy of it for your chart.

5. Make sure your pharmacist and dentist also have a current copy.

Space has been left for those who have special needs or who want to list the person named in their Durable Power for Health Care Decisions, a legal document that spells out your wishes about medical treatment if you are unable to speak for yourself.

Medical Information Form Sample

(actual size of completed, folded form)

    
     
     
     
     
     

 

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© Copyright 2001-2008 Ann Steiner, Ph.D. All rights reserved.
Reproduction without the author's written consent is prohibited.

Last Updated: August 5, 2008

 

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