Emergency Contact and Medical Form

This checklist is an easy form to document all the important information that might be needed in case of an emergency. Complete this form by entering medical history and information and contact information. Make copies of the completed form and keep one next to each telephone in your home and other locations where they can be quickly accessed for handy reference. It's also a good idea to give a copy to professionals helping your loved one and/or to staff at the facility where your loved one resides.

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