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Nov 11, 2011 - 12) Emergency Contact Name // Phone: Tammy Trama, wife // 555-555- ... 19) Last Hospital Visited // Phone: Los Angeles General Hospital ...
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ERprofile

ERdocs

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The PASSWORD to open this protected PDF file is the patient’s last 4 - digit's of phone number. 1) Full Name: Joe Trama

Date: 11-11-2011

2) Address: 123 Main St., Any Town, Ca., 10278, USA

Drivers License No: D-1234-5678

3) Phone: 555-555-1234 4) Email: [email protected] 5) Date of Birth: April 1, 1955 X Male ____ Female 6) Gender: ____

SAMPLE ONLY

7) Blood Type: O X No 8) Diabetic: ____ Yes ____ X Yes ____ No 9) Organ Donor: ____

10) Height // Weight: 6’- 0” feet // 180 pounds 11) Medical POA: Tammy Trama, wife, 555-555-1212 12) Emergency Contact Name // Phone: Tammy Trama, wife // 555-555-1212 13) Insurance Provider // Phone: Red Cross Red Shield // 555-555-1212 14) Insurance Group Number: AD-0789654 15) Insurance ID Number: HK-56784256 16) Primary Care Physician // Phone: Dr David Smith // 555-555-1212 17) Specialty Care Physician(s) // Phone: Dr Jane Graham, hip, 555-555-1212 // Dr Charles Jones, heart, 555-555-1212 // Dr Joseph Manerd, allergist, 555-555-1212. 18) Dental // Phone: Dr Banwart, Dentist, 555-555-1212 // Dr Jason Mapes, orthodontist, 555-555-1212 19) Last Hospital Visited // Phone: Los Angeles General Hospital // 480-555-1212 20) Last Lab Tests // Phone: Lab Care Co. // 555-555-1212 21) Allergies: Peanuts, sinus, penicillin. 22) Major Conditions: Asthma, allergies, high blood pressure 23) Medical Devices or Implants: 1) Titanium hips, both right and left. 2) Heart monitor in chest. 24) Regular Daily Medications: 1) FloVent Inhaler 250, 2 puffs, twice daily. SEE ADDITIONAL PAGES BELOW

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ERprofile

ERdocs

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25) Emergency Medications: Proventil inhaler 26) Special Instructions: Call my wife first, then my brother George at 555-555-1212. 27) Pharmacy: Joe’s Drug Store, 555-555-1212, 45 Main St., Any Town, Ca, 10276 28) Past Surgeries: Right and Left Hip Replacement 29) Other Important Information: NONE

SAMPLE ONLY

- END OF MEDICAL DOCUMENT -

The ERprofile password protected document can be accessed 24/7 with any web device. The ERprofile includes all your medical and contact information. The ERprofile document can be up to 4 pages of information.

ERmedcard wallet I.D.

ERdocsINFO.com MEDICAL CARD INFORMATION Scan with a QR Tag Reader or enter the following URL in your desktop computer browser: http://goo.gl/azWau

Scan QR Tag for Medical Info

The emergency responder, doctor or hospital simply scans the medcard and retrieves your complete ERprofile document.

This custom URL can also be entered into a desktop or laptop’s browser to access the ERprofile!

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