Get Keep It With You - Personal Medical Information Form - Msdh Ms

Completing the Keep It With You - Personal Medical Information Form is a vital step in ensuring that your essential medical information is readily accessible during emergencies. This guide provides clear instructions to assist you in accurately filling out the form online.

Follow the steps to complete your personal medical information form online.

1. Click ‘Get Form’ button to obtain the personal medical information form and open it in your preferred editor.
2. Begin by entering your full name and date of birth. This information helps healthcare providers identify you correctly.
3. Select your gender by choosing either 'Male' or 'Female.' If you prefer not to specify, you may leave this section blank.
4. Provide your email address, which can assist in communication with healthcare providers if necessary.
5. Fill out the details of your doctor or clinic prior to evacuation, including their name and location (city and state).
6. Enter your permanent home address, ensuring accuracy for any potential follow-ups.
7. List any known allergies to medications or other substances to alert providers of potential health risks.
8. Complete your temporary address if you are currently displaced, along with a phone number where you can be reached.
9. Document any previous evacuee center locations where you have stayed, noting the facilities and their cities.
10. Include your ID number or case number if you have this information available.
11. Identify a parent, guardian, or another support person by entering their name, contact information, and relationship to you.
12. In the 'Active Diagnoses' section, note any current health conditions that healthcare providers should be aware of.
13. Add any alerts that may be critical for your medical care.
14. List all active medications along with administration instructions, including the name of the pharmacy chain if known.
15. On the reverse side, record any healthcare encounters during your displacement, detailing dates, locations, clinician names, symptoms, tests/results, and treatment needs.
16. Attach your immunization card to the form if you have one, providing a complete record of any recent vaccinations.
17. Once you have filled out the form, review all information for accuracy, then save your changes, download the form, print it for your records, or share it as needed.

Take a moment to complete your Keep It With You - Personal Medical Information Form online for your safety and peace of mind.