Medical Emergency Contact Form

Jeanie Rosenburg, the sales manager at Gainsborough in Eugene, OR called 911 when a resident collapsed outside her office. When the EMTs arrived they wanted to know if the woman was allergic to any medicines, etc. and Jeanie didn’t know.

She had no information on file, there was none in the house, and the woman’s husband was out and could not be reached. Jeanie decided she didn’t want to be uninformed again, so she gave each resident a form to fill out, an envelope to put it in and directions to attach it to the side of their refrigerator. Because this seems so practical, we want to suggest that each of you do the same. Download this form, fill it out, and put it in a legal size envelope clearly marked“Medical Information for (your name).” Do it today, it may save your life.


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