InteliHealth:

The InteliHealth Pregnancy Profile ID Card makes it easy for you to keep important medical information at your fingertips. Simply complete the fields below, and we'll produce a personal ID card that you can print (select "Print" from the "File" menu), cut out and carry with you throughout your pregnancy. Download to your hard drive if you would like to save for future reference (select "Save As" from "File" menu).

General Information:
Name:
Address:
Day Phone:
Evening Phone:

Emergency Contact Information:
Name:
Relationship:
Emergency Phone:

Due Date:

/ /

Blood Type:

Obstetrical Care Provider And Hospital:
Name:
Address:
Day Phone:
Emergency Phone:
Hospital:
Address:
Phone:

Insurance Plan:

Insurance ID Number:

Allergies:

Current Medications:

Risk Factors (Check All That Apply):
	Preterm Labor	Epilepsy
	Multiples	HIV/AIDS
	Asthma	High Blood Pressure
	Diabetes	Smoking
	Gestational Diabetes	Alcohol/Drug Use

Medical History: (Be sure to include Caesarean delivery, miscarriage, preterm labor/delivery and toxemia/preeclampsia. Note the month(s) and year(s) that you experienced these conditions.)

Additional Information:

© 1996-2009 Aetna InteliHealth Inc. All rights reserved. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen. Use of this online service is subject to the disclaimer and the terms and conditions. External website links provided on this site are meant for convenience and for informational purposes only; they do not constitute an endorsement. These external links open in a different window. Aetna InteliHealth subscribes to the HONcode principles principles of the Health On the Net Foundation. "InteliHealth" and "The Trusted Source" are trademarks of Aetna InteliHealth Inc.

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