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My Emergency Card

Download My Emergency Card pdf document (293k) handout.

  • Name
  • Date of Birth
  • Home Phone
  • Emergency Contacts
    • Name
    • Relationship
    • Phone
  • Family Doctor
    • Phone
  • Local Clinic/Hospital
    • Phone
  • Emergency Numbers
    • Fire Department
    • Local Police Department
  • Do you have any of the following conditions?
    • Heart Disease
    • Previous Heart Attack
    • High Blood Pressure
    • Diabetes
    • Other
  • Current Medications
  • Known Allergies
  • Other Information

Read My Emergency Card in Tagalog

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Information on this page is taken from the English print version of “Healthy Heart, Healthy Family: A Community Health Worker's Manual.” U.S. Department of Health and Human Services, National Institutes of Health, National Heart Lung and Blood Institute, NIH Publication No. 08-3674, Originally Printed 1999, Revised May 2008.

Last Updated March 2012

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