Get the free MEDICAL STATEMENT For Emergency Medical Services

TENNESSEE DEPARTMENT OF HEALTH DIVISION OF HEALTH LICENSURE AND REGULATION OFFICE OF EMERGENCY MEDICAL SERVICES 665 MAINSTREAM DRIVE, 2nd FLOOR NASHVILLE, TN 37243 MEDICAL STATEMENT For Emergency

How to fill out medical statement for emergency

How to fill out a medical statement for emergency:

1. Start by clearly writing the heading "Medical Statement for Emergency" at the top of the document.
2. Provide your personal information, including your full name, address, phone number, and date of birth.
3. Indicate your primary healthcare provider's name and contact information. Include their phone number and address.
4. Write a brief statement about your medical history, including any known allergies, chronic conditions, or previous surgeries.
5. List the medications you are currently taking, including the dosage and frequency. Include any over-the-counter medications or supplements.
6. Detail any specific emergency medical instructions that should be followed in case of an emergency. For example, if you have a severe allergy, specify the required treatment or medications.
7. Provide contact information for your emergency contacts, including their full names, phone numbers, and relationships to you.
8. Sign and date the medical statement at the bottom to validate its authenticity.

Who needs a medical statement for emergency?

1. Individuals with chronic health conditions that may require specialized treatment during emergencies.
2. People with severe allergies or medical conditions that could potentially result in life-threatening situations.
3. Anyone who wants to ensure that proper medical care is provided in the event of an emergency and wants to provide clear instructions to healthcare professionals.

For pdfFiller’s FAQs

What is medical statement for emergency?

Medical statement for emergency is a legally binding document that details a person's medical history, current conditions, and emergency contact information.

Who is required to file medical statement for emergency?

Individuals with certain medical conditions or medications that may impact their ability to receive timely medical treatment in case of emergency are required to file a medical statement for emergency.

How to fill out medical statement for emergency?

Medical statement for emergency can be filled out by providing accurate and up-to-date information about one's medical history, current conditions, and emergency contact information. It is important to review the form carefully before submission.

What is the purpose of medical statement for emergency?

The purpose of medical statement for emergency is to ensure that individuals with medical conditions receive timely and appropriate medical treatment in case of an emergency. It also helps emergency responders to quickly access important medical information.

What information must be reported on medical statement for emergency?

Information such as medical history, current medications, allergies, emergency contact details, and any specific instructions or preferences in case of an emergency must be reported on a medical statement for emergency.

How can I get medical statement for emergency?

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