Patient Information Sheet

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This is a printable Emergency Medical Information sheet for your personal use.  Please print a copy for each family member, complete and post in an obvious location.  In the event that EMS is dispatched to your home and there is no one able to provide emergency information, EMS will have some basic medical information that may be beneficial to our assessment and treatment of your medical emergency.  Other than at home display you can make copies to carry in your wallet, purse or car.  If you have any questions about the use of this form please call (336) 641-7565.   

Click here to download the Emergency Information Form