Emergency Medical Sheet:

For any of us who have serious medical issues it is probably a good idea to carry a form that would be available to anyone providing emergency care to us any time. I have a single 8 x 10 sheet of paper that has information on both sides. I have a copy, in the "Male Bag"; on both of my wheelchairs. There is one in our van, one in my wife's car, another in her purse and my nurses each have one. It's folded in a way so the words EMERGENCY INFORMATION is clearly visible. A copy also sits conspicuously in an envelope on our refrigerator. Obviously, the information would vary from individual to individual but also some of the data would be the same.  One side of mine has information concerning Autonomic Dysreflexia which is a life-threatening condition that can develop very quickly when an individual has quadriplegia. The information includes warning signs of the condition and the protocol for immediate treatment. I've been in hospital emergency rooms where neither the doctors nor nurses had any idea what Autonomic Dysreflexia was or its potential. At the bottom of this section I have the website where more information on this condition can quickly be obtained. I have taken the information from a wallet card; available on the Christopher and Dana Reeve Foundation website and copied it onto the front of the sheet.


On one side of the top of the opposite side has MEDICAL INFORMATION including my address, phone number, date of birth, height, weight, blood type and other unique medical conditions I have. Next to that I have a list of previous surgeries including dates and the hospitals where they were perform. Below that is PERSONAL INFORMATION which lists all the medicine I am allergic to and all the prescription medicine and over-the-counter drugs I am taking. They are listed by morning and evening and including dosage amounts. It also lists the drugs taken as needed for pain or other temporary conditions. I update this information every time there's a change in my medications and I include the date of the last update. The paper can also be given to a doctor’s receptionist instead of filling out forms. Also included are my doctors and their phone numbers, the local ambulance number and my nurses’ numbers including their home phone, cell phone and work numbers. My wife’s cell phone number is there since she is my Health Care Proxy, has Power of Attorney and knows where my Living Will is kept. The bottom half of this page includes a copy of my Medicare card my Secondary Insurance card (front and back) and finally a copy of my enhance New York State Nondriver License which can also serve as picture identification.

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On frig

Specific Treatment side

Personal information side

Folded up