Record Of Emergency Information - Interactive Tools

Last Updated:

The Aetna InteliHealth Record Of Emergency Contact Information makes it easy to keep important information within reach for you and your child’s caregivers. Simply fill in each of the boxes below, and we’ll produce a personal record that you can print (select "Print" from the "File" menu) and cut out. Carry one copy with you, keep a second at your home and give one to your child’s caregivers. We also suggest downloading the form to the hard drive on your computer (select "Save As" from File menu), so you can update this information as needed.

Emergency Phone Numbers:

Police Department:	Ambulance:
Fire Department:	Child's Doctor:
Poison Control Center:

Parents' Phone Numbers:

Parent's Name:	Parent's Name:
Home:	Home:
Office:	Office:
Cell:	Cell:
Pager:	Pager:

Child's Doctor:

Name:	Address:
Day Phone:
Emergency Phone:

Emergency Contacts:

Name:	Name:
Day Phone:	Day Phone:
Evening Phone:	Evening Phone:
Relationship:	Relationship:
Address:	Address:

Medical Information:

Child's Name:	Child's Name:
Date Of Birth:	Date Of Birth:
Medical Problems:	Medical Problems:
Medicines:	Medicines:
Allergies:	Allergies:
Child's Name:	NOTES:
Date Of Birth:
Medical Problems:
Medicines:
Allergies:

Last updated December 1, 2008

1996-2012. Aetna 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. The Aetna InteliHealth website subscribes to the HONcode principles of the Health On the Net Foundation. "InteliHealth" and "The Trusted Source" are trademarks of Aetna Inc.

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