Who Speaks for You in a
Who accurately knows your medical history?
your spouse know what medications you
Do you live alone?
For you, your
family and friends,
Emergency Medical Data (EMD) form
member of your family and let it Speak for You !
Download and Complete this EMD:
Emergency Medical Data Sheet (EMD) English
Emergency Medical Data Sheet Spanish
Emergency Medical Data Sheet (Long
Emergency Medical Data Example
Time may be critical! Do you
really want the medics to spend precious time detailing your medical
history in an
emergency, when you could easily hand them your accurately recorded
history on paper?
you receive a visit from Emergency Medical Service they
often need to gather your medical history and other vital
information in an effort to provide the best of care. The modern ambulance crew is often licensed to administer
most drugs available in the emergency room at the hospital. They
often cannot do that without your
accurate medical history.
In addition, the first responder's time with
you will be short and they often transport you to the Hospital (ER).
That handoff transfer requires accurate patient information.
half and stop at the fold line exposing the words
"Emergency Medical Data."
Place the EMD on the outside of your refrigerator using
a refrigerator magnet or in an envelope marked
"Emergency Medical Data." A magnet will not work on
stainless steel so use an alternate attachment method. Consider including your Health Care Power
of Attorney and the No-CPR or DNR (Do Not Resuscitate)
form if you have one. The refrigerator is a known
location in homes and easy to locate. Ask your
local Fire/EMS for their preferred location.
copy of the (EMD) in the glove compartment box for each
vehicle you own and for each member of the family. First responders often look there in a vehicle
Carry a copy in your purse, wallet, backpack, laptop bag,
briefcase, suitcase, golf bag, travel bag, baby pack, etc.
think of any location where you might be without the (EMD)
and make one available.
friends you have an (EMD) sheet and the locations.
Have copies of your "Health Care Power of
Attorney" and your (No-CPR or DNR) "Do Not Resuscitate" form, if you
have one, in the same location as your (EMD). The forms won't
help if they're not readily
that live alone will often place a copy of the (EMD) in a
prominent location just as you enter their living
quarters such as on a table in the foyer and make it easily
Check first with your local
Fire/EMS Department, Police
Department, 9-1-1 Center,
Zoning Department, and the
Homeowners Association for their