I included an outline below of the information needed, and you can easily copy and paste in a word processing software and fill in all the blanks.
- Name: Date of Birth:
- Insurance:
- Height: Weight (English or metric units)
- Allergies: Reactions
- Past Medical Histories:
- Previous Surgeries:
- Medications: Name Dose Frequency
- Smoking Yes No, How long? Quit when
- Alcohol: how much and how often,
- Family History:
- DNR: Yes No DNI: Yes No MOLST: Yes No
- Health Care Proxy and Contacts Telephone Numbers
- Physicians and contact numbers
- Pharmacy with address, telephone, and fax numbers.
- Gynecological History Number of Pregnancies, outcome,
Others
EKG
CT Scan, MRI, x-rays
Blood work
Fasting blood sugar record
Stress Test
Angiograms
Implanted Devices
Biopsy results
Discharge Summaries
So there you go. Let me know if there is anything you want to add. I hope this will help and make your ER visit easier.
Related Readings:
- The Complete Series of “How to Prepare for that Unplanned Emergency Room Visit”
- Part 1 talks about why preparation is needed for an emergency room visit
- Part 2 lists the most essential medical information to bring to the emergency room.
- Part 3 describes the other medical information that are also important.
- Part 4 enumerates the different ways to carry medical information
- Part 5 lists all the needed medical information in a shortlist that can be copied and pasted to a word processing app ready to be filled.
- Disease Prevention Has a Deadline
- The Two Minute Warning
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