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Town of Holbrook Police and Fire Departments 300 South Franklin Street Holbrook, MA 02343 Medical×Alzheimer's Emergency Responder Alert Form INSTRUCTIONS: Complete this form, affix a recent photo,
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How to fill out an elderly alert form:

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Start by gathering all the necessary information for the form, such as the elderly person's full name, address, phone number, and emergency contact details.
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Make sure to carefully read the instructions provided on the form to understand any specific requirements or additional information needed.
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Fill out each section of the form accurately and legibly. If any fields are not applicable, write "N/A" or "not applicable" instead of leaving them blank.
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Provide any relevant medical information or special needs of the elderly person that may be required for emergency responders to know.
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If there is a section for the elderly person's preferences or specific instructions, make sure to include them as well.
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Finally, sign and date the form, if required, to certify its authenticity.

Who needs an elderly alert form:

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Elderly individuals living alone or in assisted living facilities can benefit from having an elderly alert form. It ensures that their vital information and emergency contacts are readily available in case of an emergency.
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Family members or caregivers of elderly individuals can also fill out this form to provide necessary information and ensure their loved ones' safety.
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Emergency responders and medical professionals can utilize the elderly alert form to quickly access important information and provide appropriate assistance to elderly individuals in need.
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Elderly alert form is a document used to report concerns about the well-being of elderly individuals who may be in need of assistance.
Any person who has concerns about the well-being of an elderly individual can file an elderly alert form.
To fill out an elderly alert form, one must provide details about the elderly individual, their living situation, any concerning behavior or health issues, and contact information for the reporter.
The purpose of the elderly alert form is to ensure that elderly individuals in need of assistance receive the help and support they require.
Information such as the elderly individual's name, age, address, specific concerns or issues, and the name and contact information of the person filing the form must be reported on the elderly alert form.
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