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Family Medical Records (cont.)

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)
Medically Reviewed by a Doctor on 12/5/2014

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