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Emergency Medical Information Form

Our goal is to help you to create a safe environment at home. Use this handy emergency medical information form to list your medical conditions, medication list, contact names and more. Emergency Responders will use this information if they need to take you to the hospital, helping to get you the right treatment fast.
Download Free EMS Emergency Medical Information Vial Of Life Form

Please print our free EMS Emergency Medical Information Form, and feel free to share it with your friends and family.


About This Free EMS Emergency Medical Information Form

Medical Care Alert offers this free EMS Emergency Medical Information Form to help keep your medical information organized and handy in the event of an actual emergency. We want you to share this form to your heart’s content. Please link or direct people to https://www.medicalcarealert.com/EMS.

How Does It Work?

When you press your Medical Care Alert button, you are connected directly to our emergency response center. If you need help, we alert life safety EMS responders (EMS, Police, Fire as needed) and give them your personal information, including the location of this Emergency Medical Information Form. When help arrives, this form speaks for you, providing life-saving information quickly to your local First Responders.

How can we prepare for an emergency?

Our EMS Emergency Medical Information Form has been reviewed by actual first responders who agree this is the right information to have on hand in an actual emergency. Complete the form, and tape it to your refrigerator where it can be easily seen by EMS responders.
Similar to a Vial Of Life form, our Emergency Medical Information Form has been reviewed and approved by emergency dispatchers. According to one Fire Department Chief who reviewed it "Your form captures more than we need for a “typical” case – but everything you ask for could be of importance in some situations." Download your EMS Emergency Medical Alert form now and place it prominently on your refrigerator where it can be easily seen.

What information should I list on the form?

This EMS Emergency Medical Information Form goes beyond the standard "Vial Of Life" type form you may get for free at a senior show.

Our printable emergency medical information form sheet has been developed with first responders to make sure we only capture the most critical information needed to assist in an emergency. When you are ready to print and complete the form, you'll want to have the following information handy:

  • Name, address, and phone numbers (include home, work and cell)
  • Who to contact in an emergency (Name, phone numbers, relationship). Note if that person also has power of attorney.
  • List any specific medical devices used, with brand and model numbers if possible (i.e. hearing aids, artificial limbs or prosthetic devices, pacemaker, defibrillator, walker, glasses, and so on).
  • Medical history and any current conditions.
  • Hospital preferences if any. (Please note that EMS may not be able to honor your wishes to take you to a specific hospital - they are not a taxi service. Their job is to get you to emergency help as fast as possible and that usually means the closest hospital location available. If you have specific needs, you can contract directly with private ambulance services or medical transportation services in your area. Just let us know to update your Personal Profile to reflect these preferences by calling Medical Care Alert customer service at 1-877-913-3680).
  • Medical Insurance Coverage
  • Doctors names and contact information, and list anything you are currently being treated for.
  • List of current medications including name of medication, dosage, frequency, reason for taking medication, and location of the medications in the home. KEEP THIS UPDATED!
  • Allergies or other sensitivities to medications or treatments.
  • Preferred pharmacy

With all that information, your emergency medical information is complete! Hopefully you'll never need it, but it can be a real help to everyone involved if you do!