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7 Key Things to Put in Your Emergency Kit

Medical History Summary Sheet

[Print or Download a Blank Form Here]

One of the most important documents that a family can keep handy is a Medical History Summary for each family member. This document helps the doctor see assess a patient's health over time. It's also helpful to have this information written out in a way that you can compare siblings, to perhaps see patterns evolving in their health.  Most importantly, this document sets the stage and informs any decisions regarding medical treatment needed for that family member.

This document is not meant to replace your doctor's files, but to be used as a quick reference, and reminder to you.  It's more important that you cover everything in that person's medical history. For each family member, include information about the following:

  • Condition(s) for which the patient is being treated by a physician. Use your own words. If you know the medical term, use it, but it's best not to guess.
  • Prescription medications being taken now or in the last six months. Include the drug name, dosage (amount) and what condition it is being taken for.  (This information is usually on the bottle or package.)
  • Frequently taken (more than once per week) non-prescription medications.  Include cough medicines, vitamins, diet pills, pain relievers, herbs, supplements, or allergy medicine you buy off the shelf at the drug store or supermarket.
  • Known allergies.
  • Any medical problems, tests or treatments, such as a broken bone, major surgery or examinations.  Include dates. Think of this list as a summary of health milestones in the person's life.

Work closely with your doctor and mention that you are compiling this list.  He or she may have additional information that they consider important enough for you to include on this summary sheet. Include notes such as "tender joints," or "high blood pressure," as communicated to you by the doctor.

For this sheet to be useful to you, your doctor or anyone responding to a medical emergency, the information must be up-to-date.  Make it a routine to pull this sheet out after a doctor's visit and add any new information. As a parent, prepare the list with the knowledge that you might not be present when it is accessed. Mothers are keepers of their child’s histories: developmental, medical and emotional. If you are unavailable, what do medical professionals need to know about your child/children?