Printable Medical Record Form

A printable medical record form can be a quick reference guide to your medical history in an emergency situation, but many people keep a copy on hand as a reminder of vital information to fill out questionnaires at routine medical appointments.

Printable forms can be useful.

When trying to decide what information to list on a printable medical record form, consider the information that would be important for a medical professional to know about you in the event of an emergency when you can't disclose medical history information. If you're incapacitated, what do the medical professionals trying to help you need to know?

• Pre-existing conditions: If you have a medical condition that would affect the way you are treated in a medical emergency, you should make sure to include this information in a prominent place on the form. Examples of these types of conditions include diabetes, heart conditions or other chronic ailments that need to be known by any medical professional treating you in an emergency.
• Allergies: There are some medications that might be used in an emergency that can be very dangerous for a person with an allergy to the medication. For your own protection, it is a good idea to list any medications that you have an allergy to or that you have experienced an adverse reaction from. This information will be invaluable to medical professionals treating you.
• Contact information for your primary physician: Emergency medical personnel will want to consult with your primary physician when the opportunity arises. Be sure that the contact phone number you list on the form is current. You should also include contact information for an emergency contact, and if the form is for a minor you should include parent or guardian contact information.
• Medications: Include a complete list of any medications you routinely take, including any over-the-counter medications and herbal supplements. You want to make sure that any emergency medications that are administered to you do not have contraindications with the medicines already in your system.

A medical record form isn't only for instances of medical emergencies. Many people use these forms in an attempt to keep their own medical history straight and to make it easier to fill out medical forms when visiting a doctor.

In addition to the information listed above, consider adding the following information to your form to make it easier to keep your medical history straight:

• A chronological list of surgeries
• A chronological list of major injuries or illnesses
• A complete listing of immunizations
• Information regarding pertinent family medical history
• Dates of last physicals
• Any pertinent medical information from other exams, including vision and dental

Women should additionally include information regarding any pregnancies or miscarriages, and if the form is updated regularly then information regarding the date of the woman's last menstrual cycle should be included.

It's simple to create a printable medical record form from your own computer using Word or Excel. Simply type out the information in an easy to read format and print it from your own printer. The easier the form is to read, the more valuable the information will be in an emergency situation.

If you prefer to print up a preexisting form and personalize the information, take a look at one of these websites for some templates and forms that you can print, some of them free of charge:

• With Purpose: This is a website written by a mom who created a printable medical record log that she offers as a free form for readers. This form is ideal for putting an entire family's medical history onto one log.
• My PHR: This website offers a variety of free medical record forms that be printed directly from the website in both Word and PDF formats.
• Records for Living: This website offers a large selection of services for keeping medical histories including printable forms and electronic recordkeeping.

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