Personal Medical History Record
Conditions and diagnoses in your own words, with the date each was first noted.
Health and medical records · HM-217 · Form
Free printable emergency medical card — contacts, the conditions and medicines you choose to list, allergies and blood group. PDF and browser versions.
One page. The A4 and US Letter files are laid out identically, so neither is shrunk to fit.
Print it and write on it
Fillable PDF type and save
Or no download needed
Fill it in onlineThe fillable versions have real form fields — open them in any PDF reader, type into them and save. Printing help.
The same sheet, on screen. Tick, type, add or remove rows, then print it or download the completed version as a PDF. Everything stays in your browser — your entries are kept in this browser's own storage on this device, nothing is uploaded, and there is no account.
One page for somebody else to read when you cannot explain. It carries your name and contacts, the conditions and medicines you decide to put on it, the allergies you have been told to mention and your blood group if you know it — short enough to be taken in quickly and plain enough to be read by anyone.
Anyone who would rather not rely on being able to answer questions, people with a condition worth mentioning early, older relatives and the family holding their paperwork, lone workers and travellers.
The printable is laid out inside a box that fits both A4 and US Letter, so the two files are identical and neither one is scaled. The fillable PDF has real form fields. The online version keeps what you enter in your own browser and builds the completed PDF on your device.
Download the A4 or US Letter file to match the paper in your printer, open it in a PDF reader and print at 100% — not "fit to page", which shrinks the writing space. Both files leave a 14 mm margin, which clears the unprintable edge on home printers. To print the online version with your entries in it, use the Print this sheet button, which prints only the sheet and none of the page around it. More on printing.
No. It is a card you write yourself, and it carries no authority. It exists so that somebody who does not know you has somewhere to start, and so that you are not answering questions at the worst possible moment.
Only what you want on it. A card kept in a wallet can be read by anyone who finds the wallet, so many people list the things that would matter quickly and leave the rest on their fuller record at home.
No. There is no instruction, no plan and no treatment on it anywhere. If you have been given a written plan by a clinician, keep the card with it and say so in the notes.
Whenever something on it changes, and put the date in the box so that anyone reading it knows how current it is. An out-of-date card is worse than none.
Yes, with their agreement, and write down who filled it in. A card that somebody else wrote is still theirs, and what goes on it is still their decision.
Conditions and diagnoses in your own words, with the date each was first noted.
Each substance with what actually happened, in your own account.
What you are taking now, in the words printed on the label.
Printable sheets, workbooks and tools on the same subject.
Put one person's emergency contacts and practical details on a single page, in the order somebody should actually work through them.
Put the numbers somebody needs in one place, so a house-sitter, a babysitter, a visiting relative or a tenant is not searching for them at the worst moment.
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