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MEDICAL INFOCARD

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General information

Name: xx
Street Address 1: xx
Street Address 2: xx 
City: xx
Province: xx
Postal Code: xx
Phone Number (Day): xx
Phone Number (Evening): xx

Front of Infocard

INFOCARD (front)
First Name: xx xx
Last Name: xx
Address 1: xx
Address 2: xx
Address 3: xx
Phone 1: 3
*Phone 2: 3
Date of Birth: 4
1In case of emergency contact:
Name: xx Phone: 3
*Name: xx *Phone: 3
*Name: xx *Phone: 3
2Medical information: xx
Doctor's Name: xx Phone: 3
*Care Card Number: xx
*Specific conditions: xx
*Drug allergies: xx
*Medication used: xx
*Blood type: xx

Notes:

  1. There should be at least one emergency contact listed. It is recommended that there be one or two alternate names and/or phone numbers listed (but this is optional). You are limited to approximately 20 characters per line per column.
  2. Your doctor's name and phone number should be listed. It is recommended that the other categories be used (adding "None" or "Not known" if they do not apply). However, you may wish to include other information that you feel is more necessary. In this case cross out the category to be replaced and write the new category beside it. There are between 5 and 7 lines available for medical information (depending on whether you have none, 1 or 2 alternate emergency contacts listed). You are limited to approximately 20 characters per line per column. If there is not enough space to list all the drug allergies or medication, further information can be listed on the back of the InfoCard, with a reference to "see over" on the front. It is recommended that you contact your doctor to discuss with him the pertinent information to include.
  3. Phone numbers should include the area code.
  4. Use the date format of d-mmm-yyyy (e.g. 18-Sep-1953) to prevent confusion.

     *   The 8 optional lines may be replaced with categories of your own if you feel they are more important than the ones listed here.

 

Back of Infocard

Practically any information you believe a Good Samaritan can use to assist you in the event of an emergency can be written on the back of the InfoCard. For example, you can include information on how to recognize a particular medical condition you may have and how to attend to make you comfortable until the medics arrive. You can also include information useful to you, such as important phone numbers. If you choose to seal a slip of paper inside the Infocard that you would like passed on to a particular individual in the event of your death or incapacitation, include the name of the recipient on the back of the InfoCard. You are limited to approximately 25 lines of approximately 40 characters each.

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If you decide to seal a message within the InfoCard, substitute the following three lines for last three above:

In the event of my death:
Please give this card to   Thank you.
 

It is recommended that you do not insert information such as credit card numbers, bank account information, or other personal information that could be used against you should the Infocard fall into the wrong hands. It is suggested that the sealed note point to a location where the named person can find further information.

Photograph

The identification photograph will be scanned from a relatively small colour head and shoulders original (such as that on a driver's license). It can also be scanned from a suitable recent family photograph or wallet-sized school photograph. A new instant digital photograph can be taken during completion of the order.

Suggestions for the use of Infocard

It is recommended that the Infocard be kept on your person at all times, but especially when you are away from home. It should be placed in something that you always carry with you (such as a wallet or a purse). It can even be attached to a belt-attached key chain or to a neck chain.. To indicate to a Good Samaritan or medic that you are carrying the InfoCard, it is advisable to wear a wristband or neck chain with words such as "INFOCARD in wallet" etched upon it.