Emergency information sheet for an aging parent: a one-page template
In an emergency nobody reads a binder. Paramedics, an ER nurse or a neighbour who found the door open need one page: who this person is, what they live with, what they take and who to call. Keep it on the fridge, in the bag, and on your phone.
What goes on the page
- Name, date of birth, and the language they prefer.
- Conditions, in the words their doctors used, and anything a stranger should know straight away: hearing, sight, mobility, memory.
- Allergies and reactions.
- Medications, copied from the labels: name, strength, when taken.
- Doctor and pharmacy, with phone numbers.
- Who to call, in order, with their relationship and number.
- Where the directive and power of attorney are, and who holds them.
- The date, so a reader knows how current it is.
Keep it current
- Reprint it whenever a medicine or a number changes.
- Date every copy and throw the old ones away.
- Tell the people on the list that they are on it.
How Alderbook does it
Alderbook's care summary is this page, built from what is already in the binder: name and date of birth, conditions and allergies as you wrote them, the medication table, doctor and pharmacy contacts, and whether a directive, POA and insurance card are on file. Share it as a PDF, print it, or open it on the phone.
Alderbook stores what you enter and gives no medical or legal advice.
Price: Free for one person and 10 documents. $49.99 once for everything else.
Printable emergency information sheet
Print it with your browser (Ctrl+P or Cmd+P); only the template prints. Or keep it in Alderbook, which fills it in for you.
Name: ______________________________
Date of birth: ______________________________
Preferred language: ______________________________
Conditions, as written by their doctor: ______________________________
Things to know straight away (hearing, sight, mobility, memory): ______________________________
Allergies and reactions: ______________________________
Directive and power of attorney are held by: ______________________________
Date of this sheet: ______________________________
| Medicine | Strength, as on the label | When taken |
|---|---|---|
| Call | Who they are | Phone |
|---|---|---|
| Doctor | ||
| Pharmacy | ||
| First | ||
| Second | ||
| Neighbour |
Filled in: an example
Fictional people and entries, to show the level of detail that helps.
Name: Margaret Ellis
Date of birth: 12 Apr 1941
Preferred language: English
Conditions: Type 2 diabetes, high blood pressure
Things to know straight away: Hearing aid in the left ear; speak from her right side
Allergies and reactions: Penicillin
Directive and power of attorney are held by: Tom Ellis (son), copies in the blue folder
Date of this sheet: 7 Sep
| Medicine | Strength, as on the label | When taken |
|---|---|---|
| Amlodipine | 5 mg | Every morning |
| Metformin | 500 mg | Twice daily with meals |
| Call | Who they are | Phone |
|---|---|---|
| Doctor | Dr Osei, Main Street Clinic | 555-0142 |
| Pharmacy | Main Street Pharmacy | 555-0170 |
| First | Tom Ellis, son | 555-0102 |
| Second | Priya Ellis, daughter | 555-0103 |
Alderbook stores what you enter and gives it back in a useful shape. It gives no medical or legal advice, calculates nothing about medication, and does not store passwords or account logins.