*Medical History Form

This one page form can be adapted to your needs. Erase what doesn’t apply and add in your own information. List your ideal serum K+, blood pressure, heart rate and other important health parametres. List your diagnoses, any drug allergies, your meds and doses, your surgical history, any other important medical information. Fold it and mark it clearly; “MEDICAL HX” and carry it with you. We keep one on the fridge in a ziplock bag, one in our wallets, one in the glove box, one in our FP’s file, and one with our emergency contact. Numerous physicians and EMTs have said, “I wish every patient carried a history like this!”

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