EMERGENCY MEDICAL IDENTIFICATION
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Autie X. Doe DOB: 02/11/1984
7777 N.W. 777 Street
Panama City, Florida 32401
(850) 555-1234 (850) 555-5678
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Emergency Contacts:
Tessa Doe, Mother (850) 555-1111 (850) 555-2222
Lisa Smith, Aunt (850) 555-3333 (850) 555-4444 |
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Physicians:
Hermon Feelgood, M.D. (850) 555-5555
Damian Quaker, M.D. (850) 555-6666 |
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Conditions/History:
Autistic (H.F.A.) Epileptic Bipolar
Athsma Diabetic Tourettes
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Medications:
Thorazine 50 mg bed time Keppra 5 mg 2 times a day
Lithium Carbonate 1 tablet Once Daily Singulair 1 tablet PRN
Insulin 10 cc PRN Navaine 5 mg PRN |
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Allergies/Other:
No Known Drug Allergy - Blood Type AB+
Halal Diet - I give consent to discuss medical conditions with anyone listed on this card. |
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____________________________________
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In Case of Emergency
See Reverse
I am a person with Autism
a neurological condition
I am not under the
influence of drugs
People with autism may:
-not understand what you say
-appear as deaf or ignore you
-dart away unexpectedly
-have limited eye contact or
social skills
-engage in repetitive behaviors
-appear insensitive to pain
-be unable to speak or have
difficulty speaking
-engage in hand flapping or
rocking
-be overly sensitive to sounds,
smell, or touch
-may not understand the law, know
right from wrong, or know the
consequences of their actions
Shouting will not help
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EMERGENCY CONTACT
INFORMATION:
Name: Autie X. Doe
Street: 7777 N.W. 777 Street
City, State: Panama City, Florida
Zip Code: 32401
Contact: Tessa Doe
Phone: (850) 555-1111
Condition: Autistic (H.F.A.)
Condition: Epileptic
Condition: Bipolar
Condition: Athsma
Condition: Diabetic
Condition: Tourettes
Meds: Thorazine 50 mg bed time
Meds: Keppra 5 mg 2 times a day
Meds: Lithium Carbonate 1 tablet Once Daily
Meds: Singulair 1 tablet PRN
Meds: Insulin 10 cc PRN
Meds: Navaine 5 mg PRN
No Known Drug Allergy
Blood Type AB+
Halal Diet
I give consent to discuss medical conditions with anyone listed on this card.
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