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"Patient Profile - Medical History Form"

Patient 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.


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