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May 20, 2013
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Family Medical Records (cont.)

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Sample History: Important Information to Carry at All Times on a Single Page

As mentioned in the previous section, useful and quick reference to personal medical records can be done most efficiently and practically on a single page, ideally printed or legibly written, to include the following information:

  • Name
  • Home address and telephone
  • Date of birth
  • Emergency contacts (family members, neighbors, or friends)
  • Physicians' name and contact information
  • Drug allergies
  • Current medications with doses and frequencies
  • Chronic medical conditions (for example: diabetes, high blood pressure, previous strokes previous heart attacks, asthma, ulcers, etc.)
  • Past operations
  • Medical insurance (health plan, phone numbers)
  • Pharmacy name and phone number
  • Advance directive, durable power of attorney for health care or POLST form (to designate another person for situations when one is not mentally capable of making one's own medical decisions)

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