Profile Form (PDF: 19KB
/ 2 page)
This free patient profile form may be
used by anyone who would like a concise way to keep all of their
medical information on hand.
All individuals are invited to use this
form to aid in identifying them and their medical history to
other healthcare providers or an ambulance crew, rescue squad,
fire or police department who might have to provide them with
care in an emergency situation when they can not communicate
information vital to their health and safety. If you are brought
to a hospital, this valuable information will also be extremely
helpful to Emergency Department physicians.
Simply print out the form, fill out the
information, and then place the form in a purse or wallet. We
suggest placing a copy of the form on your refrigerator with a
magnet or give it to a relative.