Get Vial Of Life Information Sheet-fillable - Utahcnacenters.com

The Vial Of Life Information Sheet is a crucial document that helps provide essential medical information in case of emergencies. This guide will walk you through each section of the form, ensuring that you fill it out accurately and comprehensively.

Follow the steps to complete your Vial Of Life Information Sheet

1. Press the ‘Get Form’ button to access the Vial Of Life Information Sheet. This action will open the form in the editor for you to begin filling it out.
2. Start with the personal identification section. Enter your first name, initial, and last name, followed by your street address, city, state, and zip code.
3. Provide your date of birth and marital status by selecting the appropriate option.
4. Input your social security number as requested, followed by your height and weight. Additionally, indicate your blood type and whether you have upper or lower dentures.
5. Next, detail your living arrangements by specifying who you live with and identifying your primary physician along with their phone number.
6. List your emergency contact, including their name, phone number, and relationship to you.
7. Enter your primary and secondary insurance information, including company names, policy numbers, and relevant IDs.
8. Indicate if you have an advance directive or have requested a Do Not Resuscitate (DNR) order.
9. Provide details about your hospital preference and whether you have been a patient there previously.
10. List any home health, rehabilitation, or hospice agencies you may be associated with, as well as your religious affiliation and race/ethnicity.
11. Detail your normal blood pressure and list any drug or food allergies you may have.
12. Document any medical problems or physical disabilities you have, along with a record of past surgeries.
13. Specify any assistive devices you use, like glasses, contacts, or hearing aids, and check all relevant medical conditions.
14. List your current medications, including prescriptions and over-the-counter drugs, providing the name, dosage, and frequency for each.
15. Finally, provide any additional information that you believe medical personnel should be aware of regarding your health.
16. Complete the form by signing and dating it. Ensure you have provided accurate information before saving, downloading, or printing your completed sheet.

Complete your Vial Of Life Information Sheet online for easier access during emergencies.