Free File Of Life Form in PDF

Free File Of Life Form in PDF

The File of Life form is pivotal in ensuring quick access to life-saving medical information during an emergency. This comprehensive form covers everything from current medications—prescription, over-the-counter, and supplements—to detailed personal and medical data, encompassing contacts, medical conditions, allergies, and more. It serves as a tool for emergency responders and healthcare providers to gain instant insights into a patient's health history, accelerating the decision-making process. Make sure your health information is easily accessible in emergencies by filling out the File of Life form today; just click the button below.

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In today's fast-paced world, where medical emergencies can occur unexpectedly, having quick access to one's medical information can be a lifeline. This is where the File of Life form comes into play, a crucial tool designed to speak for you when you might not be able to speak for yourself. Developed in cooperation with entities such as the Sussex County Sheriff’s Dept., Sussex County Senior Services, local volunteer fire and ambulance companies, and the Delaware State Police, the form provides first responders with immediate access to vital medical data. The form encompasses an extensive list of the medications you are taking, including prescriptions, over-the-counter medicines, vitamins, and supplements, alongside their dosages and the reason for taking them. It goes further to detail emergency medical information like your primary care doctor, preferred pharmacy, medical insurance, and emergency contacts. Also, it covers a wide range of medical conditions from heart disease to allergies, ensuring that your medical profile is comprehensively covered. It advises users to keep a copy of this form in a File of Life magnetic packet on the refrigerator, and another in their wallet or purse for emergencies. With provisions to note down recent surgeries, hospitalizations, and to designate a health care power of attorney or living will status, the form is a comprehensive tool designed for effective emergency preparedness. It emphasizes the importance of updating the information whenever there's a change in medication or medical history, offering the security of knowing that, in an emergency, the critical information needed to make informed decisions about your care will be readily available. Instructions provided for obtaining additional copies of the form or a new magnetic packet, either through contacting the Beebe Medical Center’s Community Relations Dept. or accessing it online, underline the emphasis on making this life-saving tool widely accessible.

Preview - File Of Life Form

LIST ALL MEDICINES YOU

ARE CURRENTLY TAKING

Please list prescriptions and over-the-counter medications (ex: aspirin, antacids) and herbals (ex: ginseng, ginkgo).

Make sure you include medications that you are taking routinely

and “as needed.”

Name of prescription,

 

How Often

Reason

Over-the-counter medication,

 

 

You Take

For Taking

vitamins/supplements & dose

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMERGENCY MEDICAL INFORMATION

In cooperation with: Sussex County Sheriff’s Dept.,

Sussex County Senior Services, Local Vol. Fire

and Ambulance Companies, & Delaware State Police

(Use your computer to complete this section )

Date Updated:

Name:

Address:

Sex: Male / Female

Date of Birth:

Primary Care Doctor:

Phone #:

Preferred Pharmacy:

Phone #:

Medical Insurance Co.:

Policy #:

Other Medical Insurance:

Policy #:

Medicare / Medicaid:

Policy #:

Living Will: Yes / No

Health Care Power of Attorney: Yes / No

EMERGENCY CONTACTS

Name: Phone #:

Address:

Name:

 

 

 

Phone #:

 

 

 

 

 

Address:

MEDICAL DATA

Recent Surgeries/Hospitalizations:

 

Date:

 

 

 

Update this form whenever you have a change of medication or medical history.

Keep a copy of this form in your File of Life magnetic packet, which should be placed on your refrigerator. A copy of this form also should be kept in your wallet or purse in case of emergency. For additional copies of this form or to receive a new magnetic packet, please contact Beebe Medical Center’s Community Relations Dept. at 302-645-3468. This form can also be obtained and filled out online at www.beebemed.org.

(over)

Tear on perforation and insert your updated File of Life form

into your magnetic pocket.

MEDICAL CONDITIONS

(check all that apply)

 

HEART DISEASE

LUNG DISEASE

KIDNEY

 

 

 

 

 

 

DISEASE

 

 

 

CHF/Heart Failure

 

COPD/Emphysema

 

Failure

 

 

 

 

 

 

 

 

 

 

 

High Blood Pressure

 

Asthma

 

Insufficiency

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Low Blood Pressure

 

Fibrosis

 

Dialysis

 

 

 

High Cholesterol

 

Pneumonia

 

Kidney Stones

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Irregular Heart Beat

 

Bronchitis

 

Infections

 

 

 

 

 

 

 

 

Pacemaker

 

Shortness of Breath

 

 

 

 

 

 

 

 

 

 

 

 

 

Heart Attack

 

Coughing

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Angina or Chest Pain

 

Lung Pain

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Heart Surgery/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ByPass/Stent

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STOMACH

NEUROLOGICAL

MALIGNANCY/

DISEASE

DISEASE

CANCER

Bowel Obstruction

Stroke

Lung

Bleeding

Bleeding in Brain

Liver

Diverticulitis

Seizures

Breast

Hiatal Hernia

Multiple Sclerosis

Stomach

 

 

GERD/Reflux

 

 

Parkinson

 

 

Leukemia

 

 

Diarrhea

 

Headaches

 

 

Colon

 

 

 

 

 

 

 

 

 

 

 

Blood in Stools

 

Alzheimers or

 

 

Skin

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Memory Loss

Other:

ENDOCRINE

OTHER

 

DISEASE

 

 

Diabetes

Arthritis

Vision

Thyroid:

Back Problem

Problems

High

HIV

Other

Low

Sickle Cell

 

Weight Gain

Weight Loss

ALLERGIES

(check all that apply)

 

 

 

Aspirin

 

 

Laytex

 

 

Tetracycline

 

 

 

 

 

 

 

 

 

 

 

 

 

Barbiturates

 

 

Lidocaine

 

 

X-Ray Dye

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Codeine

 

 

Morphine

 

 

No Known Allergy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Demerol

 

 

Novocain

 

 

Other:

 

 

 

 

 

 

 

 

 

 

Insect Stings

 

 

Penicillin

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Horse Serum or

 

 

Sulfa

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vaccines

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Update this form whenever you have a change of medication or medical history.

Keep a copy of this form in your File of Life magnetic packet, which should be placed on your refrigerator. A copy of this form also should be kept in your wallet or purse in case of emergency. For additional copies of this form or

to receive a new magnetic packet, please contact Beebe Medical Center’s Community Relations Dept. at 302-645-3468. This form can also be obtained and filled out online at www.beebemed.org.

UNIVERSAL MEDICATION FORM

(Use pencil on this form to allow for easy changing)

Date Updated:

Name:

Address:

Sex: Male / Female

Date of Birth:

 

 

 

 

 

 

Primary Care Doctor:

Phone #:

Preferred Pharmacy:

Phone #:

Medical Insurance Co.:

Policy #:

Other Medical Insurance:

Policy #:

Medicare / Medicaid:

Policy #:

MEDICINE ALLERGIES/REACTIONS (describe reaction)

Drug:Reaction:

Document Specs

Fact Name Description
Form Purpose The File Of Life form is designed to provide first responders and healthcare professionals with immediate access to a person's medical history, medication regimen, and emergency contacts during a crisis.
Medication Listing Individuals are encouraged to list all prescriptions, over-the-counter medications, vitamins/supplements, and their dosages, including how often and why each medication is taken, ensuring comprehensive coverage of their regimen.
Partnership The form is created in cooperation with Sussex County Sheriff’s Dept., Sussex County Senior Services, Local Volunteer Fire, and Ambulance Companies, & Delaware State Police, highlighting a community-wide approach to health and safety.
Accessibility and Updating People are advised to keep the form updated whenever there is a change in their medication or medical history, showing the document's dynamic nature intended to reflect current health status. Copies should be kept in easily accessible locations like a refrigerator or wallet.
Governing Law(s) and Procurement While there are no specific governing laws mentioned for the File Of Life form, it is obtainable through Beebe Medical Center’s Community Relations Dept. or online, indicating an organized distribution method aimed at maximizing public access and utility.

Instructions on Writing File Of Life

Filling out the File Of Life form is essential to ensure that in the event of a medical emergency, first responders have the vital information they need at their fingertips. This form is a comprehensive way to list your medical conditions, medications, allergies, and emergency contacts. It serves as a crucial tool for providing the best possible care during critical times. Below are step-by-step instructions for completing the form accurately to make sure your medical information is up-to-date and easily accessible.

  1. Start by listing all the medicines you are currently taking, including prescriptions, over-the-counter medications, vitamins, supplements, and herbal products. Make sure to include the name of each medication, how often you take it, the dose, and the reason for taking it.
  2. Proceed to the emergency medical information section. Use your computer for this part for clarity and ease of updating. Input the date updated, your full name, address, sex (male/female), date of birth, primary care doctor and contact information, preferred pharmacy and contact information, medical insurance details (including policy numbers for any extra coverage, Medicare, or Medicaid), and whether you have a living will or health care power of attorney.
  3. In the emergency contacts section, list the names, phone numbers, and addresses of your emergency contacts. These are the people who should be called in case of an incident.
  4. Under medical data, record any recent surgeries or hospitalizations, including dates.
  5. Check all applicable boxes under medical conditions to indicate which conditions you have. This section includes categories for heart disease, lung disease, kidney disease, and many more. There’s also a space to specify any conditions not listed.
  6. For the allergies section, check all that apply, and describe any medicine allergies or reactions in the space provided.
  7. Finally, remember this form should be updated regularly. Any time there is a change in your medication, medical history, or if new medical conditions are diagnosed. Once completed, keep a copy in your File of Life magnetic packet on your refrigerator and another in your wallet or purse. This ensures the information is readily available both at home and if you’re away.

After you've completed and updated your File Of Life form, ensure it's stored in its magnetic packet and placed prominently on your refrigerator. Additionally, keeping another copy in your wallet or purse can be lifesaving in situations where you are away from home. It's also important to know that for additional copies of this form or to receive a new magnetic packet, you can contact Beebe Medical Center’s Community Relations Dept. Remember, an up-to-date form can make a significant difference in an emergency by providing responders with immediate access to critical health information. Don't forget to check and update the form regularly for any changes in your medical condition, medication, or personal information.

Understanding File Of Life

What is the File Of Life form?

The File Of Life form is a document that compiles crucial personal medical data, including current medications, medical conditions, allergies, surgeries, and emergency contacts. It is designed to provide first responders and medical personnel with immediate access to your health information during an emergency, ensuring timely and effective medical treatment.

How do I fill out the File Of Life form?

The form should be filled out on your computer for clear readability. You'll need to list all current medications—prescription and over-the-counter—including vitamins and supplements. Detailed emergency medical information is also required, such as your primary care doctor, preferred pharmacy, medical insurance details, recent surgeries or hospitalizations, and any medical conditions or allergies. Remember to check the appropriate boxes for your medical conditions and allergies, and provide emergency contact information.

Where should I keep my File Of Life?

For maximum effectiveness, keep a copy in the magnetic packet provided and place it on your refrigerator. This location is commonly checked by emergency responders. Additionally, keep a copy in your wallet or purse to ensure it's with you when you're away from home. These precautions ensure your medical information is readily available in any emergency, regardless of your location.

How often should the File Of Life form be updated?

Update your form any time there is a change in your medication, medical history, or emergency contacts. Keeping the information current is vital to its effectiveness in an emergency situation. Always date the form when making updates to ensure responders are aware of its relevance.

How can I obtain additional copies or a new magnetic packet?

If you need additional copies of the File Of Life form or a new magnetic packet, contact Beebe Medical Center’s Community Relations Department at 302-645-3468. This ensures you have enough forms for multiple locations or to share with family members.

Can the File Of Life form be filled out and obtained online?

Yes, the form can be obtained and filled out online at www.beebemed.org. This option provides easy accessibility and allows you to regularly update your information as needed.

Why is it important to list all medications, including over-the-counter drugs, vitamins, and supplements?

Listing all medications is crucial because it helps healthcare providers understand your complete medication regimen, preventing negative drug interactions and ensuring they can provide the safest and most effective treatment possible. Even over-the-counter medications, vitamins, and supplements can significantly impact your health and treatment options in an emergency.

Common mistakes

One common mistake when filling out the File of Life form is not listing all medications, including over-the-counter drugs, vitamins, and supplements. It's crucial to include everything you're taking, from prescription medications to occasional aspirin, to provide a comprehensive overview of your health regimen.

Another error involves not updating the form regularly. Medical conditions and medications can change, so it's important to revise the form whenever there's a change in your health status, ensuring the information is current in case of an emergency.

Many individuals overlook the importance of including their emergency contacts' updated addresses and phone numbers. This information is vital for emergency responders or medical personnel who may need to reach these contacts quickly.

Failure to accurately record medical conditions is also a common oversight. It's essential to check all applicable boxes that apply to your health condition, including seemingly minor ailments that could become relevant in an emergency.

Omitting information about allergies can lead to dangerous situations. Whether it's a medication, food, or environmental allergy, every known allergy should be clearly documented to prevent adverse reactions during medical care.

Some people neglect to fill in their insurance information accurately. This includes not only the medical insurance company's name and policy number but also details about Medicare, Medicaid, or any secondary insurance coverage. Accurate insurance information expedites the medical care process.

Forgetting to note the preferred pharmacy, along with its contact number, is another oversight. This information can be crucial for emergency personnel trying to understand your medication history or for any follow-up care that may be necessary.

Lastly, a significant mistake is not specifying a health care power of attorney or living will status. These are critical components of your medical record, indicating your preferences for medical treatment and decision-making in situations where you might not be able to express your wishes.

Documents used along the form

When preparing for or dealing with health care situations, the File of Life form serves as a crucial document, organizing essential medical information. However, there are several other important documents and forms that are often used in conjunction with the File of Life to ensure comprehensive care and preparedness. These documents play various roles, ranging from specifying wishes regarding medical treatment to delegating decision-making authority in case one is unable to make decisions for themselves.

  • Advanced Healthcare Directive: This document allows individuals to outline their preferences for medical treatment and care in the event that they are unable to communicate their wishes.
  • Durable Power of Attorney for Healthcare: Enables an individual to designate another person to make healthcare decisions on their behalf should they become incapacitated.
  • Living Will: Specifies the types of medical care an individual does or does not want if they're unable to speak for themselves, often including directions regarding life support.
  • Do Not Resuscitate (DNR) Order: A medical order that tells healthcare professionals not to perform CPR if a patient's breathing stops or if the heart stops beating.
  • Medical Records Release Form: Authorizes the release and sharing of medical records between healthcare providers.
  • Emergency Contact Form: Lists individuals who should be contacted in an emergency, along with their relationship to the patient and contact information.
  • Medication List: Although similar information is contained in the File of Life, a separate, comprehensive medication list can provide detailed information about all medications an individual is taking, including dosages and schedules.
  • Physician's Orders for Life-Sustaining Treatment (POLST): A doctor's order that outlines a plan of care reflecting the patient's wishes concerning treatment at life's end, designed for seriously ill patients.

These documents complement each other and the File of Life form, together creating a safety net that ensures an individual's healthcare preferences are known and respected in times of crisis. Keeping these documents updated and readily available can significantly ease the burden on families during difficult times, ensuring that healthcare providers have the information and authorizations needed to deliver appropriate care.

Similar forms

The File of Life form shares similarities with the Medical ID feature found in many smartphones. Both serve as critical tools for conveying a person's medical history, allergies, medications, and emergency contacts to first responders or medical personnel during an emergency. The Medical ID can be accessed even when the phone is locked, allowing quick access to essential details without compromising the user's privacy. This immediate access can be life-saving, much like the File of Life form, which is designed to provide immediate medical facts to emergency responders. Both methods ensure vital health information is readily available, facilitating prompt and accurate medical treatment.

Another document that resembles the File of Life form is the patient information form used in medical offices and hospitals. This form typically collects comprehensive medical history, current medications, allergies, past surgeries, and emergency contacts, similar to the File of Life. While the patient information form is used to manage and streamline patient care within a medical facility, the File of Life aims to provide quick access to critical medical information in emergency situations outside of healthcare facilities. Both forms play a crucial role in ensuring that healthcare providers have the necessary information to make informed decisions about a patient's care.

Advance Directive documents, including Living Wills and Health Care Powers of Attorney, also share similarities with the File of Life. These documents guide medical care should individuals become unable to make decisions for themselves due to severe illness or incapacity. While the File of Life contains concise medical data for emergency use, Advance Directives provide detailed instructions regarding a person's preferences for end-of-life care, choice of a healthcare proxy, and other crucial decisions. Both the File of Life and Advance Directives ensure that an individual’s health care wishes are known and considered, promoting autonomy and personalized care in critical situations.

The Emergency Medical Information Form (EMIF) often given to participants in sports or travel activities closely mirrors the File of Life form. The EMIF typically includes information on medical conditions, allergies, medications, and emergency contact details, serving a similar purpose of alerting first responders and medical personnel to critical health information in the event of an emergency. Both the EMIF and the File of Life are designed to be easily accessible, ensuring that important medical information can be rapidly communicated when needed, thus enhancing the safety and well-being of individuals in emergency scenarios.

Dos and Don'ts

When filling out the File Of Life form, it’s important to accurately report your medical history and current medication usage. This information is crucial during an emergency situation. To ensure the form fulfills its purpose effectively, here are some key dos and don’ts to consider:

  • Do list all medications you are currently taking, including prescription drugs, over-the-counter medications, vitamins, supplements, and herbal products.
  • Do provide the name of each medication, how often you take it, the dose, and the reason for taking it.
  • Do update your form whenever there is a change in your medication or medical history.
  • Do include your primary care doctor’s contact information, preferred pharmacy, and medical insurance details for easy access in emergencies.
  • Do check the appropriate boxes for medical conditions, allergies, and whether you have a living will or a health care power of attorney.
  • Don’t leave out any medications, even if they are taken “as needed” or seem insignificant. Every detail can be important in a medical emergency.
  • Don’t forget to list any drug allergies you have, including the specific reaction you experience to each.
  • Don’t use pens on sections of the form meant to be updated frequently. Use a pencil so that adjustments can be made easily.
  • Don’t store the form in a place where it can’t be easily found; the File of Life should be kept in its magnetic packet on your refrigerator and a copy in your wallet or purse.

Completing the File Of Life form with thoroughness and accuracy ensures that responders have the vital information they need in an emergency. It’s an essential step in taking charge of your health and well-being.

Misconceptions

When it comes to preparing for unexpected medical emergencies, the File of Life form plays a crucial role. Unfortunately, several misconceptions exist about what the form is and how it's used. Let's clarify some of the most common misunderstandings:

  • Only for the elderly: Many believe the File of Life is exclusively for senior citizens. However, anyone, regardless of age, can benefit from having their medical information readily accessible in an emergency.
  • It's too complicated to fill out: While it might seem daunting at first glance, the File of Life form is designed to be straightforward. You're asked to list only essential medications, allergies, medical conditions, and emergency contacts, making it manageable for anyone.
  • Medical staff won't notice it: A common misconception is that in an emergency, medical personnel might overlook the form. On the contrary, the File of Life is recognized by first responders who are trained to look for these forms, particularly when placed in its magnetic packet on the refrigerator or carried in a wallet or purse.
  • Only paper copies are valid: Some might think only paper copies are accepted, but the File of Life can also be filled out and updated online. This digital option ensures you can always maintain the latest information easily.
  • It's unnecessary if you have a medical ID: Individuals with medical bracelets or IDs may feel the File of Life is redundant. While medical IDs are invaluable, the File of Life provides a comprehensive overview of your medical history, medications, and allergies, which can be crucial during emergencies.
  • It replaces the need for verbal communication: Another misunderstanding is that if you have a File of Life, you don't need to communicate with emergency personnel. While it provides vital information, it's also important to communicate as much as you can verbally, as the form complements but does not replace verbal communication.
  • Updating it is a hassle: The thought of regularly updating medical information might seem like a tedious task. However, using a pencil for the Universal Medication Form section makes it easy to keep the document current without much effort.

Understanding these aspects of the File of Life form can ensure that in emergencies, you or your loved ones have the best chance of receiving fast, accurate care. It's a simple tool that can make a significant difference when time and accuracy are critical. Don't let misconceptions prevent you from taking this small but vital step in emergency preparedness.

Key takeaways

The File of Life form is an essential tool for ensuring your health information is readily available during an emergency. Here are nine key takeaways about how to effectively fill out and use this form.

  • List all your current medications, including prescriptions, over-the-counter drugs, vitamins, supplements, and herbals.
  • It’s important to include the medicine name, dosage, how often you take it, and why you take it.
  • The form allows you to record important emergency medical information, such as your primary care doctor, preferred pharmacy, medical insurance details, and whether you have a living will or health care power of attorney.
  • Emergency contacts should be updated with their current phone numbers and addresses.
  • Make sure to check off any medical conditions you have, which can range from heart disease to allergies.
  • Remember to update the form anytime there is a change in your medication or medical history.
  • Keep a copy of the form in the File of Life magnetic packet on your refrigerator and another in your wallet or purse for emergencies.
  • To obtain additional copies or a new magnetic packet, contact the provided community relations department or visit their website.
  • Using a pencil to fill out the universal medication form section can make it easier to update changes in your medication.

Staying proactive with the File of Life form ensures that first responders have immediate access to critical health information when it matters most.

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