This document will help you in an emergency. Print out two copies and fill in the blanks. Keep one copy with you, and give one to your spouse or traveling companion. Also, be sure to pack your child’s prescription medicines (and bring them along if you have to take your child to a doctor or an emergency room) and a first-aid kit so you can cope with minor medical problems. In addition, purchase medical protection insurance for travel before you leave, if possible, and keep a copy of your policy with you.
My child’s personal information
My child’s name:
Height and weight:
Social security number:
My child’s doctors
My child’s doctor at home:
If possible, get a referral from your pediatrician before you leave:
My child’s health insurance
Be sure to take health insurance ID cards with you, and before you depart, check your policy or call your insurance company to check on coverage when you’re away from home.
My child’s emergency contacts
My child’s medical history
Allergies to medicines:
Medications (prescription and nonprescription; note exact names and dosages):
Immunization history (attach a vaccination record to this sheet):
Previous hospitalizations, surgeries:
Vaccination record for COVID-19 (take a copy with you):
For more information:
Call Ask-a-Nurse, a 24-hour service that locates nurses in many states; contact information at http://www.ask-a-nurse.com.
Robert H. Pantell M.D., James F. Fries M.D., Donald M. Vickery M.D., Taking Care of Your Child: A Parent’s Illustrated Guide to Complete Medical Care. Perseus Books Publishing.