vial of life medical information form
This kit can save your life in the event of a medical emergency when paramedics and first responders arrive. One decal goes on your front door at eye level.
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Take this important step to prepare yourself for an emergency.
. A Vial of Life sticker is placed on the vial which is then put in the participants refrigerator in plain view. This EMS Emergency Medical Information Form goes beyond the standard Vial Of Life type form you may get for free at a senior show. Sponsored by American Senior Safety Agency Phone Toll Free 888 473-2800.
Enter StoreSMARTs Vial of Life Pockets a quick and easy way to provide medical responders with potentially life-saving health informationand FAST. Dell our Vial of Life is a medical information form where you can list any medications or a medical conditions you have and any additional medical information you would need a paramedic to know in an emergency. If you dont have an account yet register.
Answer all or any pertinent questions. This information is provided by the patient. Durham County EMS will provide participants with a refrigerator magnet a vehicle sticker a medicine bottle labeled Vial of Life and a patient information form.
Fill out the medical information form in pencil. Vial of Life keeps your medical information nearby in case of emergency. The VIAL OF LIFE is a container that holds information about you that is important for medical personnel who responds when you are in need of emergency care.
The Vial of Life is designed to speak for you when you cant speak for yourself. VIAL OF LIFE documents can be your voice in the event that you are unresponsive. Complete all the required fields these are yellowish.
It will come in this clear plastic sleeve where you can go ahead and fill out and place it on the refrigerator once youre done. To use the Vial of Life properly in your home you must have 2 of our UV-coated Vial decals. Select the template you will need in the library of legal form samples.
Patient agrees to hold harmless Home Caregivers Home Health and the Vial of Life program for any outcomes based on discrepancies errors or omissions. The Vial of Life is designed to speak for you when you cant speak for yourself. Emergency responders can make the best decisions regarding treatment when they are aware of an individuals medical history medications and allergies.
6 o Alle ies to Medications. Help medical personnel make the best decisions regarding emergency treatment. Spreading the word about the VIAL OF LIFE will allow others to.
Your contact information including date of birth Social Security number and primary language. Its the right thing to do. Vial of LIFE Lifesaving Information for Emergencies The Vial of LIFE Lifesaving Information for Emergencies is an easy way for seniors or anyone to have important medical information on hand just in case of an emergency.
The Vial of Life form includes the following sections. Another Vial of Life sticker is placed on the front door to alert emergency personnel that medical information is located inside. To get your FREE Vial of Life kit limit 1 free kit per person while supplies last.
All information on this form is optional but being thorough and providing as complete information as you can helps emergency crews help you. Click on My Signature. Simply contact the Office of EMS at 321-633-2056 and request a Vial which contains a medical information form and two green Vial of Life stickers.
Our printable emergency medical information form sheet has been developed with first responders to make sure we only capture the most critical information needed to assist in an emergency. The VIAL OF LIFE program is just another way that NDDH helps to promote protect and improve your health. 4 x 9 Vial of Life.
Make blank copies of this form to keep your information current or maintain and store your updated information online with us. Add additional documentation as necessary. Complete Vial Of Life Form in just a few minutes by using the instructions below.
The free Vial of Life kit consists of a medical information form plus decals to let responding emergency medical workers know this information is available. Your doctors name and phone number. Answer all or any pertinent questions.
The Vial of Life kit includes a door decal a Vial of Life pill bottle and Vial of Life important medical information document. Health insurance information including the company name and your policy or Medicare number. Place the completed Vial of Life inside your refrigerator on a shelf in the fridge door close to eye level with as much visibility as possible.
Each tool contains your medical information such as a list of your current medications to help loved ones or first responders administer the proper treatment or care in an emergency situation. To the refrigerator door for your medical documents. The vial contains important medical information that can assist emergency personnel in administering the proper medical treatment Alameda.
The holder contains your up to date medical information and your picture is placed in the smaller pocket on the back of the holder. Below is a list of step-by-step instructions for the preparation of the Vial of Life. Easy Magnetic Opening -.
Fill out the Vial of Life form. Print out the VOL Personal Med Info 022015 pdf. Ordering your decals online is easy.
The information you should include would be a recent picture medications. Fill Out the Vial of Life Form Fill out the form located on reverse side. Fill out the backside of the Vial of Life form.
Complete the Medical Information Form. All fields are optional. Everybody should have a Vial of Life form filled out.
Click on the Get form button to open it and begin editing. Open the doc and select the page that needs to be signed. Search for the document you need to eSign on your device and upload it.
Seniors need this because of their constant medical changes and medications. Vial of Life Project. What to do once you have a Vial of Life.
The VIAL OF LIFE is recognized internationally. Place the decal on front of a plastic. It cannot be relied upon for complete accuracy.
Get vial of life form pdf signed right from your smartphone using these six tips. How to use it. The form has areas for personal data past medical history allergies advanced directives current medications caregiver information communication methods sensory stimulus and emergency contact numbers.
Vial of Life participants complete a medical information form which is placed into a medicine vial. The Vial of Life is Free because it should be. EMERGENCY MEDICAL INFORMATION FOR RESCUE SQUAD.
The Vial of Life is a smart way to have your medical information on hand just in case of an emergency. Vial of Life and File of Life are two life-saving tools that are designed to speak for you during a medical emergency when you may not be able to speak for yourself. Medical information is located.
It is an important personal medical information form that can assist emergency personnel in administering the proper medical treatment. A sheet of instructions is also included inside the kit. You can have one in your home andor car and it does not take up much room.
The names and numbers of emergency contacts.
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