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Kids Corner After School Program Health and Emergency Form CHILD HOME ADDRESS SCHOOL DATE OF BIRTH HOME PHONE GRADE EMERGENCY CONTACTS 1) (Parent/Guardian #1) (Cell Phone) (Home Address) (Home Phone)

How to fill out health and emergency card

How to fill out a health and emergency card:

1. Start by writing your full name on the designated space provided. Make sure to avoid any abbreviations and write your name exactly as it appears on official documents.
2. Next, fill in your date of birth. Write the day, month, and year in the specified format.
3. Provide your complete contact information. This should include your current address, phone number, and email address. It's important to provide accurate and up-to-date contact details so that emergency responders can easily reach you or your designated emergency contact.
4. Specify any known medical conditions or allergies that you have. This information is crucial for medical professionals in case of an emergency. Be concise and clear when listing your conditions or allergies.
5. Indicate any medications that you are currently taking. Include the name of the medication, the prescribed dosage, and the frequency at which you take it. This information will help healthcare providers provide appropriate treatment or avoid any potentially harmful drug interactions.
6. Provide the contact information of your primary healthcare provider or physician. This can include their name, office address, and phone number. In case of an emergency, having the contact information readily available can be vital for coordinating your care.
7. Write down the name and contact information of your emergency contact person. This should be someone who can be reached easily and is aware of your medical condition and history. It is recommended to choose a person who knows you well and can effectively communicate with healthcare professionals on your behalf if needed.

Who needs a health and emergency card:

1. Individuals with pre-existing medical conditions: If you have a known medical condition, carrying a health and emergency card can provide essential information to healthcare professionals in case of an emergency. It can help them understand your condition better and guide your treatment accordingly.
2. Elderly individuals: Older adults often have multiple medical conditions and may require regular medications. Having a health and emergency card on hand can assist in providing accurate and timely medical care during critical situations.
3. Individuals with severe allergies: People who have severe allergies, especially those that can cause life-threatening reactions, should carry a health and emergency card. This allows emergency responders to quickly identify and address potential allergens to prevent adverse reactions.
4. Individuals participating in high-risk activities: If you engage in activities such as extreme sports, adventure travel, or hazardous occupations, having a health and emergency card becomes even more crucial. In the event of an accident or injury, it provides vital information that can influence the treatment you receive.

Remember, it's important to keep your health and emergency card updated regularly. Review the information periodically and make any necessary changes to ensure its accuracy. Additionally, always carry the card with you or keep it in a readily accessible location in case of emergencies.

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