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Integrated Health Welcome Name Phone () DOB Address City State Zip Email: Referred by: Phone () In case of emergency: Phone () Occupation MaleFemalePhysician Health Insurance Carrier Please take a

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How to fill out in case of emergency

01

Stay calm and assess the situation.

02

Call emergency services if necessary (e.g., 911).

03

Provide clear and concise information about the emergency.

04

Follow any instructions given by emergency personnel over the phone.

05

Administer first aid if trained and necessary.

06

Evacuate the area if instructed to do so.

07

Gather important documents and personal belongings, if possible.

08

Follow any predetermined emergency plans or procedures.

09

Stay updated on the situation through reliable sources.

10

Cooperate with emergency responders and follow their instructions.

11

Take care of yourself and others affected by the emergency.

12

After the emergency, seek necessary medical attention or support as required.

Who needs in case of emergency?

01

Anyone who is present at the scene of an emergency.

02

Individuals who are directly involved or affected by the emergency.

03

Bystanders who can assist or provide aid to those in need.

04

Emergency responders and medical professionals.

05

Family members or loved ones of individuals involved in the emergency.

06

Community members who can offer support or resources.

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