Checklist: Emergency info

Posted Friday, March 23, 2007 7:46 PM

Q: I want to put together a sheet of emergency information, but I'm not sure what to put on it. What should I include?

A: Smart move. Terrifying as it is to consider, emergencies can happen. Prepare yourself by completing this checklist and posting a copy by every phone in your home. Yes, some of the information is quite basic -- but even the simplest fact can slip your mind during a crisis. And, you'll never regret being overly prepared. Sign the release to consent to emergency medical care for baby in your absence.

Emergency Info: 

[  ] Mom's work phone:

[  ] Mom's cell phone:

[  ] Dad's work phone:

[  ] Dad's cell phone:
 

[  ] 911

[  ] Poison control: 1-800-222-1222

[  ] Police department:

[  ] Fire department phone:

[  ] Other local/appropriate emergency numbers:

[  ] Child's doctor:

[  ] Doctor phone:

[  ] Child's chart number: (if appropriate)

[  ] Child's dentist:

[  ] Dentist phone:

[  ] Preferred hospital:

[  ] Hospital phone:

[  ] Address:

[  ] Directions:
 

[  ] Emergency contact 1:

[  ] Phone number(s):

[  ] Relation:
 

[  ] Emergency contact 2:

[  ] Phone number(s):

[  ] Relation:
 

[  ] Closest neighbor:

[  ] Phone number(s):

[  ] Address:

[  ] Home address:

[  ] Closest major intersection:
 

[  ] Mom's full name:

[  ] Dad's full name:
 

[  ] Child's full name:

[  ] Child's date of birth:

[  ] Any allergies, medications or special conditions:
 

[  ] Insurance provider:

[  ] Insurance provider phone:

[  ] Insured name and ID:

[  ] Group ID:

[  ] Policy ID:
 

[  ] Release: I, _______________, authorize any licensed physical, dentist or hospital to give _______________, born _______________, all necessary emergency medical services.  

Sign:                             Date:
 

QA Index