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UPDATED FORM REQUIRED EACH YEAR 2023INDEPENDENCE PLUS EMERGENCY INFORMATION FORM Name: ___ Address: ___ Phone: ___Emergency Contacts: Name: ___Name: ___Phone: ___Phone: ___Phone: ___Phone: ___Relationship:
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How to fill out independence plus emergency information

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Gather all relevant personal information including name, address, phone number, and emergency contacts.
02
Make a list of any medical conditions, allergies, and medications that you are currently taking.
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Include details about any mobility aids or devices that you use on a regular basis.
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Keep all documents in a safe and easily accessible location in case of an emergency.

Who needs independence plus emergency information?

01
Anyone who lives alone or spends a significant amount of time by themselves.
02
Individuals with medical conditions or disabilities that may require assistance in an emergency situation.
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Independence plus emergency information is a form that includes details about a person's emergency contact information, medical conditions, allergies, and other important information for emergency situations.
All individuals who require special assistance or accommodations in case of emergencies are required to file independence plus emergency information.
Independence plus emergency information can typically be filled out online or on a paper form provided by the relevant organization. It is important to include accurate and up-to-date information.
The purpose of independence plus emergency information is to ensure that individuals with special needs or medical conditions can receive the appropriate assistance in case of an emergency.
Information such as emergency contacts, medical conditions, allergies, medications, mobility limitations, communication preferences, and any specific needs or accommodations should be reported on independence plus emergency information.
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