Not medical advice. The content on this page is for informational and support purposes only. It is not a substitute for professional medical diagnosis, treatment, or guidance. Always consult a qualified healthcare provider with questions about a medical condition or treatment plan.
Every caregiver should have an emergency information sheet for their loved one — and it should be somewhere easy to find. Not buried in a filing cabinet. On the fridge. In a wallet. Shared with every person who might ever need to step in. This template covers everything that matters.
Personal Information
Start with the basics:
- Full legal name
- Date of birth
- Home address
- Primary language (and any communication needs)
- Photo (especially important for individuals with dementia who may wander)
This section seems obvious, but in a crisis — when you're panicked, when someone else is stepping in, when first responders arrive — having it written down clearly is invaluable.
Medical Information
This is the core of the sheet:
- Primary diagnoses (in plain language)
- Current medications (name, dose, frequency) — or attach the medication tracker
- Known allergies (medications, foods, environmental) — mark clearly with ALLERGY in bold
- Blood type (if known)
- Recent surgeries or procedures (with dates)
- Medical devices (pacemaker, insulin pump, hearing aids, etc.)
- Mobility aids (walker, wheelchair, cane)
- Cognitive status (e.g., 'Has dementia — may be confused and frightened; approach calmly')
- Behavioral notes (e.g., 'Becomes very anxious in loud environments')
Update this section every time there is a change in diagnosis, medication, or condition.
Emergency Contacts
List at least three contacts in priority order:
Contact 1 (Primary caregiver): Name / Relationship / Phone (cell) / Phone (home) / Email
Contact 2 (Secondary caregiver or family member): Name / Relationship / Phone / Email
Contact 3 (Backup — neighbor, close friend): Name / Relationship / Phone / Email
Also include:
- Healthcare proxy / Power of Attorney: Name and phone
- Primary care physician: Name, practice, phone
- Specialist(s): Name, specialty, phone
- Pharmacy: Name, phone, address
- Insurance: Provider name, policy number, phone
Advance Directives & Legal Documents
This section tells first responders and medical staff about your loved one's documented wishes:
- Do Not Resuscitate (DNR) order: Yes / No — if yes, note where the document is kept
- Advance Directive / Living Will: Yes / No — location
- Healthcare Proxy / Medical Power of Attorney: Yes / No — name of proxy and location of document
- POLST / MOLST form (Physician Orders for Life-Sustaining Treatment): Yes / No — location
Keep copies of these documents with the emergency sheet. First responders need to be able to find them quickly.
Where to Keep This Sheet
An emergency sheet is only useful if people can find it. Keep copies in these locations:
- On the refrigerator — this is where emergency responders are trained to look
- In your loved one's wallet or purse
- In the glove compartment of any car they travel in
- With every regular caregiver or family member who provides care
- In a shared digital folder (Google Drive, Dropbox) accessible to key family members
- With your loved one's primary care physician
Review and update the sheet every six months, or whenever there is a significant change in health status, medications, or contact information.