Homepage Free File Of Life PDF Template
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Ensuring quick access to life-saving medical information during emergencies is crucial, and this is where the File Of Life form comes into play. Designed for efficiency and ease of access, the form encompasses a comprehensive catalog of an individual's medical history, including all prescribed medications, over-the-counter drugs, supplements, and any herbal products they might be taking. It demands specifics such as the name of the medication, dosage, how often it's taken, and the reason for taking it. Apart from medication details, the form provides a section to fill in vital emergency medical information. This includes the collaboration of various organizations such as the Sussex County Sheriff’s Dept., Sussex County Senior Services, Local Vol. Fire and Ambulance Companies, & Delaware State Police, ensuring the form's effectiveness and credibility. The form also incorporates the individual’s primary care doctor, preferred pharmacy, medical insurance details, living will status, health care power of attorney, emergency contacts, a detailed medical history including recent surgeries or hospitalizations, medical conditions, allergies, and even medicine allergies or reactions. It's recommended to update this form whenever there's a change in medication or medical history. Keeping a copy in an easily accessible place, such as the File Of Life magnetic packet on a refrigerator and another in a wallet or purse, ensures emergency responders can find crucial information swiftly. For acquiring additional copies or a new magnetic packet, one can contact specified medical centers or obtain the form online, highlighting the importance of keeping this life-saving information updated and within reach in case of an emergency.

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LIST ALL MEDICINES YOU

ARE CURRENTLY TAKING

Please list prescriptions and over-the-counter medications (ex: aspirin, antacids) and herbals (ex: ginseng, ginkgo).

Make sure you include medications that you are taking routinely

and “as needed.”

Name of prescription,

 

How Often

Reason

Over-the-counter medication,

 

 

You Take

For Taking

vitamins/supplements & dose

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMERGENCY MEDICAL INFORMATION

In cooperation with: Sussex County Sheriff’s Dept.,

Sussex County Senior Services, Local Vol. Fire

and Ambulance Companies, & Delaware State Police

(Use your computer to complete this section )

Date Updated:

Name:

Address:

Sex: Male / Female

Date of Birth:

Primary Care Doctor:

Phone #:

Preferred Pharmacy:

Phone #:

Medical Insurance Co.:

Policy #:

Other Medical Insurance:

Policy #:

Medicare / Medicaid:

Policy #:

Living Will: Yes / No

Health Care Power of Attorney: Yes / No

EMERGENCY CONTACTS

Name: Phone #:

Address:

Name:

 

 

 

Phone #:

 

 

 

 

 

Address:

MEDICAL DATA

Recent Surgeries/Hospitalizations:

 

Date:

 

 

 

Update this form whenever you have a change of medication or medical history.

Keep a copy of this form in your File of Life magnetic packet, which should be placed on your refrigerator. A copy of this form also should be kept in your wallet or purse in case of emergency. For additional copies of this form or to receive a new magnetic packet, please contact Beebe Medical Center’s Community Relations Dept. at 302-645-3468. This form can also be obtained and filled out online at www.beebemed.org.

(over)

Tear on perforation and insert your updated File of Life form

into your magnetic pocket.

MEDICAL CONDITIONS

(check all that apply)

 

HEART DISEASE

LUNG DISEASE

KIDNEY

 

 

 

 

 

 

DISEASE

 

 

 

CHF/Heart Failure

 

COPD/Emphysema

 

Failure

 

 

 

 

 

 

 

 

 

 

 

High Blood Pressure

 

Asthma

 

Insufficiency

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Low Blood Pressure

 

Fibrosis

 

Dialysis

 

 

 

High Cholesterol

 

Pneumonia

 

Kidney Stones

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Irregular Heart Beat

 

Bronchitis

 

Infections

 

 

 

 

 

 

 

 

Pacemaker

 

Shortness of Breath

 

 

 

 

 

 

 

 

 

 

 

 

 

Heart Attack

 

Coughing

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Angina or Chest Pain

 

Lung Pain

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Heart Surgery/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ByPass/Stent

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STOMACH

NEUROLOGICAL

MALIGNANCY/

DISEASE

DISEASE

CANCER

Bowel Obstruction

Stroke

Lung

Bleeding

Bleeding in Brain

Liver

Diverticulitis

Seizures

Breast

Hiatal Hernia

Multiple Sclerosis

Stomach

 

 

GERD/Reflux

 

 

Parkinson

 

 

Leukemia

 

 

Diarrhea

 

Headaches

 

 

Colon

 

 

 

 

 

 

 

 

 

 

 

Blood in Stools

 

Alzheimers or

 

 

Skin

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Memory Loss

Other:

ENDOCRINE

OTHER

 

DISEASE

 

 

Diabetes

Arthritis

Vision

Thyroid:

Back Problem

Problems

High

HIV

Other

Low

Sickle Cell

 

Weight Gain

Weight Loss

ALLERGIES

(check all that apply)

 

 

 

Aspirin

 

 

Laytex

 

 

Tetracycline

 

 

 

 

 

 

 

 

 

 

 

 

 

Barbiturates

 

 

Lidocaine

 

 

X-Ray Dye

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Codeine

 

 

Morphine

 

 

No Known Allergy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Demerol

 

 

Novocain

 

 

Other:

 

 

 

 

 

 

 

 

 

 

Insect Stings

 

 

Penicillin

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Horse Serum or

 

 

Sulfa

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vaccines

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Update this form whenever you have a change of medication or medical history.

Keep a copy of this form in your File of Life magnetic packet, which should be placed on your refrigerator. A copy of this form also should be kept in your wallet or purse in case of emergency. For additional copies of this form or

to receive a new magnetic packet, please contact Beebe Medical Center’s Community Relations Dept. at 302-645-3468. This form can also be obtained and filled out online at www.beebemed.org.

UNIVERSAL MEDICATION FORM

(Use pencil on this form to allow for easy changing)

Date Updated:

Name:

Address:

Sex: Male / Female

Date of Birth:

 

 

 

 

 

 

Primary Care Doctor:

Phone #:

Preferred Pharmacy:

Phone #:

Medical Insurance Co.:

Policy #:

Other Medical Insurance:

Policy #:

Medicare / Medicaid:

Policy #:

MEDICINE ALLERGIES/REACTIONS (describe reaction)

Drug:Reaction:

Document Attributes

Fact Name Description
Form Purpose The File Of Life form is designed to keep track of all current medications, emergency medical information, emergency contacts, medical conditions, and allergies to assist healthcare and emergency services in case of an emergency.
Collaborating Organizations This form is developed in cooperation with Sussex County Sheriff’s Dept., Sussex County Senior Services, Local Vol. Fire and Ambulance Companies, & Delaware State Police, emphasizing its approved use and reliability in emergencies.
Accessibility The form is accessible and can be updated either by obtaining a physical copy through Beebe Medical Center’s Community Relations Dept. or online, allowing for easy and timely updates to personal medical information.
Storage Recommendations It is recommended to keep a copy of this form in a magnetic packet on the refrigerator and a portable copy in one's wallet or purse, ensuring the information is readily available both at home and when out.

How to Fill Out File Of Life

Starting with the File Of Life form marks an important step to ensure your emergency medical information is easily accessible in the event it's needed. This document contains vital details regarding your health status, prescription medications, medical conditions, allergies, and emergency contacts, allowing first responders immediate access to your medical background. Keeping this information updated and readily available can significantly impact the effectiveness and speed of emergency medical assistance provided to you.

To accurately complete the File Of Life form, please follow these steps:

  1. Gather all your current medication information, including prescriptions, over-the-counter medications, vitamins, and supplements. Note down how frequently you take these and for what reason.
  2. Fill out the "EMERGENCY MEDICAL INFORMATION" section. Begin by entering the date you last updated the form, your name, address, sex, date of birth, primary care doctor with phone number, preferred pharmacy with phone number, medical insurance company with policy number, and, if applicable, your Medicare/Medicaid policy number.
  3. In the specified fields, indicate whether you have a living will and if there is an active health care power of attorney.
  4. Enter the names, phone numbers, and addresses of your emergency contacts.
  5. Under "MEDICAL DATA," document any recent surgeries or hospitalizations, including dates.
  6. Check the applicable boxes under "MEDICAL CONDITIONS," which cover a broad range of common health concerns from heart disease to allergies.
  7. Be sure to update the form with any changes in your medication or medical history.
  8. Store a completed copy in the File of Life magnetic packet on your refrigerator as well as in your wallet or purse for emergencies.
  9. For additional copies of the form or to get a new magnetic packet, contact Beebe Medical Center’s Community Relations Dept. at 302-645-3468, or visit their website www.beebemed.org.
  10. Your form is now complete. Remember, it's crucial to keep this information current and to place it where it can be easily found in an emergency.

Upon finishing your File Of Life form, ensure copies are placed both in the magnetic packet on your refrigerator and in your wallet or purse. Considering the dynamic nature of health information, keep the form updated with any change in medications, medical conditions, or emergency contacts. In times of need, this form becomes an invaluable resource for emergency responders, allowing them to make informed decisions swiftly, potentially saving lives.

More About File Of Life

FAQ Section: Understanding the File of Life Form

  1. What is the File of Life form?

    The File of Life form is a document that allows individuals to record crucial medical information, including current medications, allergies, medical conditions, emergency contacts, and more. It is designed to provide first responders and medical personnel with immediate access to your health history during an emergency, facilitating prompt and accurate care.

  2. Why is it important to list all medications on the File of Life form?

    Listing all medications, including prescription drugs, over-the-counter treatments, vitamins, and supplements, is critical because it helps medical providers understand your current treatments and avoid potential drug interactions or allergic reactions. This comprehensive list should include how often and why you take each medication.

  3. How often should the File of Life form be updated?

    You should update the form whenever there is a change in your medication, medical condition, or any other significant change in your health status. Keeping the information current ensures that the data available to emergency personnel is accurate and up-to-date.

  4. Where should I keep my File of Life?

    You should keep a copy of the File of Life form in a magnetic packet on your refrigerator, as recommended. Additionally, carrying a copy in your wallet or purse ensures that it is accessible in case of an emergency away from home.

  5. How can I obtain a File of Life magnetic packet or additional forms?

    Additional copies of the form or a new magnetic packet can be requested from the Beebe Medical Center’s Community Relations Department at 302-645-3468, or the form can be filled out and obtained online at the provided website.

  6. Which medical conditions should be reported on the File of Life form?

    The File of Life form includes sections for reporting various medical conditions such as heart disease, lung disease, kidney issues, neurological disorders, malignancies, endocrine diseases, and other significant health issues. It's important to check all that apply to ensure a complete health profile is available to caregivers.

  7. Why is it necessary to list allergies on the File of Life form?

    Listing allergies, including medications, food, and environmental allergies, is crucial for avoiding potential allergic reactions during medical treatment. This information can save valuable time and prevent complications in emergency situations.

  8. What should I do if I don’t have any known allergies or medical conditions?

    If you do not have any known allergies or medical conditions, it is still advisable to fill out the form with this information clearly indicated. This lets emergency medical personnel know that these factors have been considered and assessed, ensuring that no crucial information is overlooked during an emergency.

Common mistakes

Filling out the File Of Life form accurately is crucial, as it provides first responders and medical personnel with immediate access to your essential medical information during an emergency. However, several common mistakes can lead to inaccuracies or omissions that might hinder the effectiveness of this vital tool. Below are seven such errors to avoid:

  1. Not updating the form regularly: One of the most common mistakes is failing to update the form whenever there's a change in medication, medical history, or emergency contacts. Health conditions and medications can change over time, making it imperative to keep this information current.

  2. Incomplete medication details: Many individuals list their medications but forget to include the dosage, how often they take it, and the reason for taking it. This information is critical for emergency personnel to understand your regimen fully.

  3. Omitting over-the-counter medications, vitamins, and supplements: It's essential to list all substances you're taking, including over-the-counter meds, vitamins, and supplements, as they can interact with prescription medications and affect treatment options.

  4. Forgetting to list allergies: Failing to note all allergies, especially to medications, can lead to dangerous or even life-threatening situations in an emergency. Always include any known allergies to drugs, foods, and other substances.

  5. Leaving out emergency contacts: Neglecting to provide or update information for at least two emergency contacts can slow down the process of getting in touch with your loved ones in critical situations.

  6. Ignoring medical conditions and recent surgeries: Some people overlook the importance of listing their medical conditions and any recent surgeries or hospitalizations. This is essential information that helps medical personnel provide the best and most expedient care.

  7. Using illegible handwriting: If you're filling out the form by hand rather than online, ensure your handwriting is clear and legible. Poor handwriting can lead to misinterpretations that could affect your care.

By avoiding these mistakes, you can ensure that your File Of Life form is an accurate and helpful resource in any emergency situation. Remember to keep a copy in your refrigerator's magnetic pocket and another in your wallet or purse for easy access by emergency responders.

Documents used along the form

When preparing for a medical emergency or managing ongoing health conditions, it's essential to have all needed documentation readily available. The File Of Life form plays a critical role in this process by ensuring that medical personnel have access to vital health information. In addition to the File Of Life, there are several other forms and documents that are often used together to provide a comprehensive view of a person's medical history and preferences.

  • Advance Directive: This document outlines a patient's wishes regarding medical treatment if they are unable to communicate these decisions themselves. It often includes specifics about life-sustaining treatments they want or do not want.
  • Do Not Resuscitate (DNR) Order: A crucial document that indicates that a person does not wish to have CPR or other life-saving measures if their heart stops or if they stop breathing.
  • Medical Power of Attorney (Health Care Proxy): Assigns a trusted individual the authority to make healthcare decisions on behalf of the patient if they’re incapacitated.
  • Living Will: Although sometimes part of an advance directive, a living will specifically outlines the types of medical treatments and life-sustaining measures an individual desires or refuses.
  • Medical History Summary: Provides a detailed account of an individual’s medical history, including past surgeries, chronic conditions, and significant illnesses or injuries.
  • Medication List: Separate from the File Of Life, this comprehensive list includes all medications being taken, dosages, and the prescribing doctor, which should be regularly updated.

Together, these documents ensure that healthcare providers have a full picture of an individual's health preferences and conditions, leading to more personalized and effective care. It's recommended to keep these documents in an easily accessible location and inform a family member or friend of their existence and where they can be found. Regularly updating these forms to reflect any changes in health status, medications, or personal wishes is also crucial.

Similar forms

The File Of Life form is a crucial document designed to provide first responders and medical personnel with immediate access to an individual's medical history, allergies, medications, and emergency contacts in a crisis. Several other documents share similarities with the File Of Life form, each serving a unique yet critical role in managing an individual's health and personal information. Outlined below are seven such documents:

  • Medical Alert Bracelet Information: Similar to the File Of Life, medical alert bracelets contain vital health information that can be accessed quickly during emergencies, including allergies, chronic conditions, and medications.
  • Advanced Directive: This document outlines an individual's preferences for medical treatment and end-of-life care. Like the File Of Life, it communicates important health care decisions when the person cannot.
  • Emergency Contact List: Though it focuses primarily on providing contact information for relatives or friends in case of an emergency, this list shares the idea of ready accessibility with the File Of Life.
  • Personal Health Record (PHR): PHRs are comprehensive records maintained by individuals that track their medical history, treatments, and test results over time, akin to the detailed medical and medication history provided in the File Of Life.
  • Medication List: Specific to listing all current medications, including over-the-counter drugs and supplements, medication lists share a similar function with the File Of Life, helping to ensure accurate medication management.
  • Insurance Information Cards: While these cards primarily serve as proof of insurance, they also include vital information such as policy numbers and contact info for medical providers, resembling the emergency contacts and insurance details in the File Of Life.
  • Doctor's Visit Summary: These summaries provide overviews of what happened during a medical appointment, including any changes to medication or treatment plans, resembling how the File Of Life is updated with medical history or changes in medication.

Each of these documents plays a vital role in managing an individual's health care and ensuring that critical information is accessible when needed most, echoing the purpose of the File Of Life form.

Dos and Don'ts

When completing the File of Life form, it's important to provide accurate and comprehensive medical information. Here are a few recommendations on what you should and shouldn't do to ensure the form is filled out correctly and effectively:

Do's:

  • Be thorough when listing your medications. Include all prescription drugs, over-the-counter medications, vitamins, supplements, and herbal products you regularly use or take on an "as needed" basis. Detail the name, dosage, frequency, and reason for taking each.
  • Update your form regularly. Anytime you experience changes in your medications or health status, update the form. This ensures that the information remains current, which is crucial in case of an emergency.
  • Provide detailed emergency contact information. Include the names, phone numbers, and addresses of your emergency contacts. Having this information readily available can be invaluable during a crisis.
  • Check all medical conditions that apply. Accurately indicating your medical conditions can provide first responders with quick insights into potential health complications you may face.
  • Specify any allergies or reactions to medication. This information can be life-saving, preventing medical personnel from administering drugs that you have a bad reaction to.
  • Keep a copy in a readily accessible place. Alongside storing the File of Life form in your magnetic packet on the refrigerator, keep another copy in your wallet or purse. This makes the information easily accessible both at home and away.

Don'ts:

  • Don’t leave sections blank. If a section does not apply to you, such as certain medical conditions or allergies, make sure to mark it accordingly. This avoids any assumptions about your health status.
  • Don't use difficult-to-erase writing tools. For sections that are subject to change, like the medication list, use a pencil. This makes updating the form easier and keeps it legible over time.
  • Avoid unclear or abbreviated information. When listing medications or medical conditions, be as clear as possible. Abbreviations or shorthand notes might not be understood by all medical professionals.
  • Don’t forget to list over-the-counter medications and supplements. Even non-prescription drugs and natural products can have significant interactions with other medications or impact your health during an emergency.
  • Don't neglect to list all your medical providers. Include contact information for your primary care doctor and preferred pharmacy. This may be crucial for emergency personnel needing to consult with your healthcare providers.
  • Don't leave out insurance information. Having your medical, and if applicable, Medicare or Medicaid policy numbers on hand can expedite treatment and admission processes in emergencies.

Misconceptions

There are several misconceptions about the "File Of Life" form that can lead to hesitation or misuse by individuals. Understanding and correcting these misconceptions ensures that everyone can benefit fully from this potentially life-saving tool. Here are five common misconceptions explained:

  • Only for the Elderly: While seniors may have a more immediate need due to chronic conditions, the File Of Life is beneficial for individuals of all ages. It ensures that accurate medical information is readily available for emergency responders, regardless of the patient's age.
  • Complex to Fill Out: Some believe the form is too complicated or time-consuming. In reality, it is straightforward, focusing on essential medical information such as medications, medical conditions, allergies, and emergency contacts. It is designed for ease of use to encourage broad participation.
  • Medical Responders Don't Use It: Contrary to this belief, emergency personnel are trained to look for information like that provided in the File Of Life. This form can significantly expedite medical treatment by giving first responders quick access to critical health information.
  • It's a Replacement for Verbal Communication: Another misconception is that if you have filled out this form, there's no need to communicate with medical personnel about your health history. Although the File Of Life provides essential information at a glance, verbal communication, when possible, is vital and can provide additional context and clarification.
  • Not Necessary if You're Healthy: Health status can change unexpectedly, and emergencies can happen to anyone. The form also includes emergency contact information, which is crucial in any urgent situation. Therefore, having this information readily available is a proactive measure for anyone, regardless of current health condition.

The File Of Life form is a simple yet critical tool in ensuring your medical information is accessible in emergencies. It empowers individuals and families to take an active role in their healthcare by keeping important information in an easily accessible format for emergency responders. Correcting misconceptions and spreading the word about the importance of this form can save lives by providing first responders with the information they need when it matters most.

Key takeaways

The File of Life form serves as an essential tool in preparing for medical emergencies by organizing critical health information in a readily accessible manner. Here are five key takeaways for accurately completing and utilizing this form:

  1. Maintain Current Information: It's vital to keep the information on your File of Life form up-to-date. Regularly review and update the form following any changes in medications, medical conditions, or personal information like your address or emergency contacts. This ensures that in the event of an emergency, responders have the most current data to guide your care.

  2. Comprehensive Medication Listing: Make sure to list all medications, including prescriptions, over-the-counter drugs, vitamins, supplements, and herbal treatments you are currently taking. Specify the dose, how often you take each medication, and the reason for taking them. This comprehensive approach helps prevent adverse drug interactions and ensures that emergency personnel can make informed decisions about your care.

  3. Emergency Contacts: Provide detailed information for at least two emergency contacts. Include their full names, relationship to you, phone numbers, and addresses. Having multiple contacts increases the likelihood that someone will be available quickly in an emergency situation.

  4. Health Directives: Clearly state whether you have a living will or a health care power of attorney. These directives guide medical personnel and loved ones in making care decisions that align with your preferences, especially in situations where you may not be able to express your wishes.

  5. Accessibility: Keep a copy of your completed File of Life form in its magnetic packet on your refrigerator and another copy in your wallet or purse. This ensures that it is easily accessible to emergency responders or health care providers whether you are at home or outside. For additional security and convenience, consider sharing a copy with your primary emergency contact.

Remember, the purpose of the File of Life is to convey critical health information quickly and accurately in an emergency. Taking the time to fill out this form completely and keep it updated can significantly impact the effectiveness of emergency response and potentially save your life.

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