Personal
Information
Staying on top of your health history can be challenging. The
records in this guide can help you keep track of information. First, record
your background information here. You can access other records for
preventive care, cancer
tests, flu shots, tetanus shots, pneumonia
shots, and medicines.
Name:_________________________________________________________________
Address: _____________________________________________________________
______________________________________________________________________
______________________________________________________________________
Telephone: ___________________________________________________________
Emergency Contact: ___________________________________________________
______________________________________________________________________
Allergies: ___________________________________________________________
______________________________________________________________________
______________________________________________________________________
Doctor's Phone Number(s) : __________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Medical Insurance Number(s): ________________________________________
______________________________________________________________________
|
|
Get the Savvy Consumer Newsletter! (FREE)