{"id":571,"date":"2000-01-01T12:00:00","date_gmt":"2000-01-01T12:00:00","guid":{"rendered":"https:\/\/care-givers.com\/articles\/emergency-information\/"},"modified":"2021-06-29T20:31:34","modified_gmt":"2021-06-29T20:31:34","slug":"emergency-information","status":"publish","type":"post","link":"https:\/\/care-givers.com\/articles\/emergency-information\/","title":{"rendered":"Emergency Information"},"content":{"rendered":"

Whether you live long distance or are directly caring for your loved one, it is important to have detailed information readily at hand for emergency purposes. You must know what documents are needed and where they are located. This information should be accessible for yourself and those who will be caring for your loved one if you are not available.<\/p>\n

Please remember to keep all this information up to date. By preparing this information, you be insuring that you are better prepared should emergencies arise. We encourage you to print out these pages, keeping them in a safe place, preferably a binder or envelope. Click on the links to access the forms for printing<\/p>\n

Carerecipient:
\n<\/b><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\n
Name:_____________________<\/div>\n<\/td>\n
\n
Nickname:_______________<\/div>\n<\/td>\n
.<\/td>\n<\/tr>\n
\n
Address______________________________________________<\/div>\n<\/td>\n
<\/td>\n<\/tr>\n
\n
City: _____________________<\/div>\n<\/td>\n
\n
State: _______<\/div>\n<\/td>\n
\n
Zip: ________<\/div>\n<\/td>\n<\/tr>\n
\n
Phone: ___________________<\/div>\n<\/td>\n
\n
Social Security #:_________________Blood\u00a0Type: ____<\/div>\n<\/td>\n<\/tr>\n
\n
Disease(s)\/ Illness\/ Condition:<\/div>\n<\/td>\n
_____________________<\/td>\n_______________________<\/td>\n<\/tr>\n
______________________<\/td>\n_____________________<\/td>\n_______________________<\/td>\n<\/tr>\n
\n
Organ Donation Status: __________________________________________________<\/div>\n<\/td>\n<\/tr>\n
\n
Other Important Info: _____________________________________________________<\/div>\n<\/td>\n<\/tr>\n
_____________________________________________________________________<\/td>\n<\/tr>\n
_____________________________________________________________________<\/td>\n<\/tr>\n
_____________________________________________________________________<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Caregiver:<\/p>\n\n\n\n\n\n\n\n
\n
Name:_____________________<\/div>\n<\/td>\n
\n
Nickname:_______________<\/div>\n<\/td>\n
<\/td>\n<\/tr>\n
\n
Address______________________________________________<\/div>\n<\/td>\n
<\/td>\n<\/tr>\n
\n
City: _____________________<\/div>\n<\/td>\n
\n
State: _______<\/div>\n<\/td>\n
\n
Zip: ________<\/div>\n<\/td>\n<\/tr>\n
\n
Home Phone:_________________Business Phone:________________ Ext:\u00a0\u00a0___<\/div>\n<\/td>\n<\/tr>\n
\n
Relationship To Carerecipient: ____________<\/div>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Caregiver:<\/p>\n\n\n\n\n\n\n\n
\n
Name:_____________________<\/div>\n<\/td>\n
\n
Nickname:_______________<\/div>\n<\/td>\n
.<\/td>\n<\/tr>\n
\n
Address______________________________________________<\/div>\n<\/td>\n
<\/td>\n<\/tr>\n
\n
City: _____________________<\/div>\n<\/td>\n
\n
State: _______<\/div>\n<\/td>\n
\n
Zip: ________<\/div>\n<\/td>\n<\/tr>\n
\n
Home Phone:_________________Business Phone:________________ Ext:\u00a0\u00a0______<\/div>\n<\/td>\n<\/tr>\n
\n
Relationship To Carerecipient: ____________<\/div>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Emergency Phone Numbers:<\/p>\n\n\n\n\n\n
\n
911 <\/b><\/div>\n<\/td>\n
\n
Police: __________________<\/div>\n<\/td>\n
\n
Fire: ________________<\/div>\n<\/td>\n<\/tr>\n
\n
Ambulance: _______________ Hospital: __________________<\/div>\n<\/td>\n<\/tr>\n
\n
Others: ______________________________________________________________<\/div>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Spouse, Significant Other, Relative, Friend or Neighbor:
\n<\/b><\/p>\n\n\n\n\n\n\n\n
\n
Name:_____________________<\/div>\n<\/td>\n
\n
Nickname:_______________<\/div>\n<\/td>\n
<\/td>\n<\/tr>\n
\n
Address______________________________________________<\/div>\n<\/td>\n
<\/td>\n<\/tr>\n
\n
City: _____________________<\/div>\n<\/td>\n
\n
State: _______<\/div>\n<\/td>\n
\n
Zip: ________<\/div>\n<\/td>\n<\/tr>\n
\n
Home Phone:_________________Business Phone:________________ Ext:\u00a0\u00a0___<\/div>\n<\/td>\n<\/tr>\n
\n
Relationship To Carerecipient: ____________<\/div>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Spouse, Significant Other, Relative, Friend or Neighbor:<\/p>\n\n\n\n\n\n\n\n
\n
Name:_____________________<\/div>\n<\/td>\n
\n
Nickname:_______________<\/div>\n<\/td>\n
<\/td>\n<\/tr>\n
\n
Address______________________________________________<\/div>\n<\/td>\n
<\/td>\n<\/tr>\n
\n
City: _____________________<\/div>\n<\/td>\n
\n
State: _______<\/div>\n<\/td>\n
\n
Zip: ________<\/div>\n<\/td>\n<\/tr>\n
\n
Home Phone:_________________Business Phone:________________ Ext:\u00a0\u00a0___<\/div>\n<\/td>\n<\/tr>\n
\n
Relationship To Carerecipient: ____________<\/div>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Doctor(s):<\/p>\n\n\n\n\n\n\n\n
\n
Name:________________________________<\/div>\n<\/td>\n<\/tr>\n
\n
Address______________________________________________<\/div>\n<\/td>\n
<\/td>\n<\/tr>\n
\n
City: _____________________<\/div>\n<\/td>\n
\n
State: _______<\/div>\n<\/td>\n
\n
Zip: ________<\/div>\n<\/td>\n<\/tr>\n
\n
Home Phone:_________________Business Phone:________________ Ext:\u00a0\u00a0___<\/div>\n<\/td>\n<\/tr>\n
\n
Type Of Doctor: ____________<\/div>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n\n\n\n\n
\n
Name:________________________________<\/div>\n<\/td>\n<\/tr>\n
\n
Address______________________________________________<\/div>\n<\/td>\n
<\/td>\n<\/tr>\n
\n
City: _____________________<\/div>\n<\/td>\n
\n
State: _______<\/div>\n<\/td>\n
\n
Zip: ________<\/div>\n<\/td>\n<\/tr>\n
\n
Home Phone:_________________Business Phone:________________ Ext:\u00a0\u00a0___<\/div>\n<\/td>\n<\/tr>\n
\n
Type Of Doctor: ____________<\/div>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n\n\n\n\n
\n
Name:________________________________<\/div>\n<\/td>\n<\/tr>\n
\n
Address______________________________________________<\/div>\n<\/td>\n
<\/td>\n<\/tr>\n
\n
City: _____________________<\/div>\n<\/td>\n
\n
State: _______<\/div>\n<\/td>\n
\n
Zip: ________<\/div>\n<\/td>\n<\/tr>\n
\n
Home Phone:_________________Business Phone:________________ Ext:\u00a0\u00a0___<\/div>\n<\/td>\n<\/tr>\n
\n
Type Of Doctor: ____________<\/div>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Pharmacy<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n
\n
Name:________________________________<\/div>\n<\/td>\n<\/tr>\n
\n
Address______________________________________________<\/div>\n<\/td>\n
<\/td>\n<\/tr>\n
\n
City: _____________________<\/div>\n<\/td>\n
\n
State: _______<\/div>\n<\/td>\n
\n
Zip: ________<\/div>\n<\/td>\n<\/tr>\n
\n
Phone:________________ Hours: ____________________________________<\/div>\n<\/td>\n<\/tr>\n
Medications: ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
\n
Allergies ____________ ________________ _________________<\/div>\n<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
\n
Allergies To Medications: <\/b>______________ _______________ _______________<\/div>\n<\/td>\n<\/tr>\n
Special Instructions: _______________________________________________________________ ________________________________________________________________________________<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Health Insurance Company(s):
\n<\/b><\/p>\n

Medicare<\/b><\/p>\n\n\n\n\n\n
Policy #: ___________________________ Phone #: ___________________ Ext: ____<\/td>\n<\/tr>\n
Contact: _____________________ Address: ______________________________<\/td>\n<\/tr>\n
City: __________________________ State: _________ Zip: _________<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Medicaid<\/p>\n\n\n\n\n\n
Policy #: ___________________________ Phone #: ___________________ Ext: ____<\/td>\n<\/tr>\n
Contact: _____________________ Address: ______________________________<\/td>\n<\/tr>\n
City: __________________________ State: _________ Zip: _________<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Medigap
\n<\/b><\/p>\n\n\n\n\n\n
Policy #: ___________________________ Phone #: ___________________ Ext: ____<\/td>\n<\/tr>\n
Contact: _____________________ Address: ______________________________<\/td>\n<\/tr>\n
City: __________________________ State: _________ Zip: _________<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Workers Compensation
\n<\/b><\/p>\n\n\n\n\n\n
Policy #: ___________________________ Phone #: ___________________ Ext: ____<\/td>\n<\/tr>\n
Contact: _____________________ Address: ______________________________<\/td>\n<\/tr>\n
City: __________________________ State: _________ Zip: _________<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Social Security Disability
\n<\/b><\/p>\n\n\n\n\n\n
Policy #: ___________________________ Phone #: ___________________ Ext: ____<\/td>\n<\/tr>\n
Contact: _____________________ Address: ______________________________<\/td>\n<\/tr>\n
City: __________________________ State: _________ Zip: _________<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Veterans Administration
\n<\/b><\/p>\n

 <\/p>\n\n\n\n\n\n
Policy #: ___________________________ Phone #: ___________________ Ext: ____<\/td>\n<\/tr>\n
Contact: _____________________ Address: ______________________________<\/td>\n<\/tr>\n
City: __________________________ State: _________ Zip: _________<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Other<\/b>
\n<\/b><\/p>\n\n\n\n\n\n
Policy #: ___________________________ Phone #: ___________________ Ext: ____<\/td>\n<\/tr>\n
Contact: _____________________ Address: ______________________________<\/td>\n<\/tr>\n
City: __________________________ State: _________ Zip: _________<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

 <\/p>\n

Copyright 2000 by Gail R. Mitchell<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"

Here is a list of emergency information that should be readily available.<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5,20],"tags":[],"ppma_author":[38],"class_list":["post-571","post","type-post","status-publish","format-standard","hentry","category-caregiver-issues","category-forms-downloadable-printable"],"authors":[{"term_id":38,"user_id":6,"is_guest":0,"slug":"gail-mitchell","display_name":"Gail Mitchell","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/?s=96&d=mm&r=g","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":""}],"_links":{"self":[{"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/posts\/571","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/comments?post=571"}],"version-history":[{"count":2,"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/posts\/571\/revisions"}],"predecessor-version":[{"id":5205,"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/posts\/571\/revisions\/5205"}],"wp:attachment":[{"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/media?parent=571"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/categories?post=571"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/tags?post=571"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/ppma_author?post=571"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}