{"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","author_category":"","first_name":"Gail","last_name":"Mitchell","user_url":"","job_title":"","description":"

Ms. Mitchell began her full-time caregiving experience in the early eighties when her husband was diagnosed with cancer. Later on she became the primary caregiver for her father, along with her mother who had become critically ill from burnout prior to her dad\u2019s passing. In recent years, she cared for several friends with AIDS while continuing to care for her mother and actively providing support, information, referrals and resources for caregivers.<\/p>\r\n\r\n

Gail's leadership on the Internet and her success with Empowering Caregivers led her to found National Organization For Empowering Caregivers (NOFEC) INC in 2001.<\/p>\r\n\r\n

Prior to founding NOFEC, she created the iVillageHealth Chat: Empowering Caregivers, which she hosted for over 5 years. Within a month of hosting she created Empowering Caregivers: www.care-givers.com in 1999 as a resource for caregivers around the globe. Over three million visitors have frequented the website.<\/p>\r\n\r\n

She has presented at national and international care-related conferences and programs and has been a keynote speaker for many programs as well.<\/p>\r\n\r\n

Ms Mitchell has assisted thousands of caregivers online and offline in ways to empower themselves in their roles in caring for loved ones.<\/p>\r\n\r\n

For a list of clients and\/or her resume, please contact info@care-givers.com<\/a><\/p>\r\n\r\n

Gail's articles have been published in many venues nationally and in Canada. Presently, she is a member of American Society on Aging and National Quality Caregivers Coalition.<\/p>\r\n\r\n

Gail has discovered that there is life after caregiving: She has become a successful ceramic artist and installation\r\n artist. She created Crystal Illumination Art to bring the transformative quality of illumination, light and color to\r\n the human experience and celebrate its ability to inspire, heal and nourish our physical, mental, emotional and\r\n spiritual well being.<\/p>"}],"_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}]}}