Please print out this page, complete it and place it inside your phone book for quick reference during an emergency. Print and complete a form for each person living with you.
|Social Security Number|
|Date of Birth|
|Health Care Plan|
|Doctor's Phone Number|
|Emergency Contact & Phone|
|Medic Alert #:|
|Advanced Directive (Living Will, No CPR, etc.) Where is the information located?|
For information on how to become part of Medic Alert Medical Information Systems, contact 1.800.825.3785.