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The average person's wallet is bursting with all kinds of cards--credit, debit, business, library--but, not the one that could save their life: Medical ID. It's the one card that, in the event of an accident, will answer all the medical questions you may not be able to, such as "What's your blood type?" "Are you taking medications?" and "Do you have any drug allergies?" Think of it as an EMT cheat sheet. Without it, treatment might be delayed.

Sample Card

NOTE:  The information below is not retained or used. All fields are optional.

Enter Your Information Below:
First Name	Int.	Last Name	Date of Birth

Street Address	City	State	Zip Code
		AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY

Physician Information:
First Name	Last Name	Phone Number

Emergency Contacts:
First Name	Last Name	Phone Number
Relationship
First Name	Last Name	Phone Number
Relationship

Medical Conditions:  (For example, diabetes, coronary artery disease, congestive heart faliure)
Primary Medical Conditions
(1)		(2)
(3)		(4)
(5)		(6)

Your Medication:  (Enter drug name, dosage, and frequency. Example: Prozac, 10MG, 1xDay)
Drug Name	Dosage	Frequency
Drug Name	Dosage	Frequency
Drug Name	Dosage	Frequency
Drug Name	Dosage	Frequency
Drug Name	Dosage	Frequency
Drug Name	Dosage	Frequency
Drug Name	Dosage	Frequency
Drug Name	Dosage	Frequency

Known Allergies:
(1)		(2)
(3)		(4)
(5)		(6)

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 Blood Type     Organ Donor Yes   No

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This information is not retained nor used for any purpose other than generating and printing your medical information card.

Note: Kettering Health Network makes no guarantee regarding the accuracy or completeness of the information entered above. Information on the card is generated based on the information supplied by the user completing this card. Any risk arising from the use of the information above remains with the user.

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