Your Heart, Your Life: A Community Health Worker's Manual for the Hispanic Community
Session 2 Handout My Emergency Card
Download My Emergency Card (22k) handout.
- Date of Birth:
- Home Phone:
- Emergency Contacts (Name, Relationship, Phone for each):
- Family Doctor and Phone:
- Local Clinic/Hospital and Phone:
- Current Medications:
- Known Allergies:
- Other Information:
- Fire Department:
- Local Police Department:
Do you have any of the following conditions?
- Heart Disease (Yes or No)
- Previous Heart Attack (Yes or No)
- High Blood Pressure
(Yes or No)
- Diabetes (Yes or No)
Back to Session 2
Information on this page is taken from the English print version of “Your Heart, Your Life, 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