Click Here to Print Your FREE Emergency Contact ID Card Today!
 
 

 

In an emergency situation, you may not be able to speak and give vital information concerning your health. A Emergency Information Card is invaluable in providing information about you to treatment personnel.

We have a personalized Emergency Information Card that you can generate and update by typing your medical information into the form below. There is nothing to download or install.  To generate your Emergency Information Card, complete the form below and click the "Generate" button. A new printable page will appear with your Information Card. Review the information you submitted to be sure that it is correct.

Print the card and simply cut along the outline and fold in half to carry in your wallet or purse. Laminate your card for more durability.

If you would prefer to print a blank card, CLICK HERE.

The information below is not retained or used for any purpose other than generating your Emergency Information Card.  All fields are optional, but put as much information as possible to assist emergency personnel:

Please Note:  Keep your answers as short as possible so that they all fit neatly on the card.

Your Personal Information
First Name
Middle Initial
Last Name
Street Address
City
State
Zip
Phone 1
Phone 2
Date of Birth
Blood Type
Your Physician Information
Physician #1 Name
Physician #1 Phone
Physician #2 Name
Physician #2 Phone
Emergency Contacts
Contact #1 Name
Contact #1 Phone
Contact #2 Name
Contact #2 Phone
Current Medical Conditions
Enter your current medical conditions, diseases and history, i.e., Diabetes, Heart Disease, Congestive Heart Failure, etc., keeping your answers as short as possible so they will fit neatly on the card.
Condition #1 Condition #4
Condition #2 Condition #5
Condition #3 Condition #6
Current Medications
Enter Drug Name, Dosage and Frequency.  Frequency means how often you take the drug.
Ex:  Prednisone Ex:  10mg Ex: 4x Day
Drug Name #1 Dosage Frequency
Drug Name #2 Dosage Frequency
Drug Name #3 Dosage Frequency
Drug Name #4 Dosage Frequency
Drug Name #5 Dosage Frequency
Drug Name #6 Dosage Frequency
Drug Name #7 Dosage Frequency
Drug Name #8 Dosage Frequency
Drug Name #9 Dosage Frequency
Drug Name #10 Dosage Frequency
Known Allergies
Enter medications, food or other items to which you are allergic.
Substance #1 Substance #3
Substance #2 Substance #4
Living Will and DNR
Do you have a Living Will? 
Do you have a Do Not Resuscitate (DNR) order either verbal or written? 
 
None of the information entered here will be stored for any purpose or will be given away or used in any manner.

Please Note: We do not guarantee the completeness or accuracy of this information. Information on the card is generated based on the user supplied information above. Any risk arising out of use of this information remains with the user.

 
 
DBSA Northeast Georgia | P.O. Box 170 | Avondale Estates, GA 30002  |  Contact Us

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