Emergency Medical Form
Use our Emergency Medical Form to prepare for a worst-case scenario and quickly provide front-line workers with the necessary information to save crucial time in an emergency.
Fact Checked by RJ Gumban.
What is an Emergency Medical Form?
As medical professionals, you definitely have considered what would happen if someone in your care had a medical emergency. Whether it's an employee, a client, a student, or a child you're looking after, they may be unable to convey crucial medical information themselves.
Luckily, you can prepare for the worst-case scenarios. Even though we hopefully never have to use it, our Emergency Medical Form is designed to give you peace of mind that you'll be able to access the information medical providers or first responders may need quickly in an emergency.
Our Emergency Medical Form includes spaces for personal information, medical history, current medications, allergies, emergency contacts, and emergency medical authorization for an adult or child patient.
Time is of the essence in an emergency, so having an emergency information form already filled out and accessible for anyone who may need it is a great way to save crucial minutes and maximize the possibility of a good outcome for the patient.
Printable Emergency Medical Form
Download these templates for emergency medical forms to improve your therapy intake process and HIPAA compliance.
Why is this form useful for physicians?
This form gives physicians the information they need to make informed clinical decisions on their patient's behalf. In an emergency, the patient may be unconscious or unable to convey the necessary information. As such, being prepared with completed emergency medical information is a fantastic idea as in an emergency- every second spent trying to gather information could count toward whether someone survives an emergency.
Our Emergency Medical Form provides physicians with your current medications, any existing medical conditions, emergency contact details, and allergies. This information may prove crucial in an emergency.
How does our Emergency Medical Form template work?
We've kept this Emergency Medical Form template concise so anyone using it in an emergency doesn't have to search through multiple pages. Everything that needs to be filled in is on a single page, so once you've downloaded the free PDF from the link on this page, let's go through the different steps to filling in this form.
Step 1: Ensure you gather personal information accurately
Begin by collecting relevant information, such as the patient's name, address, and date of birth. This information is crucial for swiftly accessing medical records during an emergency, streamlining the process, and saving valuable time.
Step 2: Obtain emergency contact information
The emergency contact is the primary point of contact in a medical emergency. Encourage patients to select someone who resides nearby or is readily reachable during emergencies. Record their name, phone number, and relationship to the patient for efficient communication.
Step 3: Document medical history
Proceed to document the patient's medical history, including any existing medical conditions, current medications, allergies, and all information that could aid in effectively managing an emergency.
Step 4: Establish emergency medical consent
Facilitate the process of emergency medical consent, empowering individuals to authorize medical care on their behalf or behalf of a dependent in case of an emergency. Get the patient's name, the authorized individual or entity, and the designated person responsible for granting consent. If the consent pertains to a child or dependent, complete the parent or guardian section accordingly.
Step 5: Ensure accessibility and security
Emphasize the importance of securely storing the completed form in a readily accessible location for emergencies. Whether maintaining physical copies or storing digital records, ensure easy retrieval alongside other essential information for swift action when needed.
Emergency Medical Form example (sample)
Look at our example below to better understand how to use this Emergency Medical Form and how it can be helpful in a medical emergency. You can download the free interactive template from the link on this page or examine the example Emergency Medical Form as a PDF.
Download this Emergency Medical example (sample) here:
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Who can use this printable Emergency Medical Form?
This Emergency Medical Form is super versatile for use across all different fields. Take a look at just some of the individuals this form can prove beneficial to:
Emergency department physicians and nurses
Perhaps the most apparent user choice for an Emergency Medical Form is the people who see emergencies daily, that is, doctors, nurses, paramedics, or other clinical staff who work in emergency departments. By having a form already filled out, you ensure these front-line workers who will be the first to arrive on the emergency scene have the information they need to make life-saving decisions.
Schools, daycares, or kindergartens
Once a child's parent drops them off for the day, they can be confident that information is provided if their child has a medical emergency. Our Emergency Medical Form is ideal for schools, daycare facilities, kindergartens, or any institution that looks after minors.
Employers
Companies would be prepared with their medical information if an employee had a medical emergency. The form makes a great addition to a new employee's induction documentation. It will give both the company and employees peace of mind that their life-saving information is accessible if ever it is needed.
Assisted living or aged care facilities
The aging population may be taking several medications or have had specific medical treatments or conditions that will change how they need to be treated in an emergency. Ensuring this information is stored in writing and accessible when needed will help you offer the best possible care for your residents.
Nannies or babysitters
Even if it's just for the odd night here and there, ensure you are prepared for the worst-case scenario. By having your clients fill in an emergency medical information form for the children you are looking after, you can demonstrate your initiative and capability for your service.
Meta Description: Use our Emergency Medical form to prepare for a worst-case scenario and quickly provide front-line workers with the necessary information to save crucial time in an emergency.
Commonly asked questions
If you manage the storage of emergency medical information forms, don't delay. Offer the medical information to the first responders at the medical emergency or the doctors at the emergency department. In an emergency, offering information is better than holding it back, thinking it won't be relevant.
Healthcare providers emphasize the necessity of having an Emergency Medical Form, particularly for individuals with conditions like severe allergies, diabetes, epilepsy, or a history of strokes or heart disease. Ensuring pertinent health information is readily available to employers, housemates, or caregivers can facilitate swift and appropriate medical intervention during emergencies.
The time it takes to complete an Emergency Medical Form can vary depending on factors such as the individual's medical history, familiarity with their current medications, and the level of detail required. Generally, it may take a few minutes to around half an hour to fill out the form thoroughly and accurately.
