Keep important information together with a blank form you can complete for yourself or someone you support. This printable includes spaces for emergency contacts, allergies and reactions, current medications, medical conditions, and a healthcare provider. The download is empty and contains no personal information.
Blank Printable Emergency Medical Information Form
Download the printable PDF | Download the full-size PNG image
What can you record?
Use the contact rows for names, relationships, and phone numbers. Separate areas allow you to write allergies and reactions, medication details, and other information you want available. A last-updated field helps you tell whether a copy needs review.
How to use this printable
- Download and print the blank PDF.
- Complete the fields privately using information you have checked.
- Include the date when you last reviewed the sheet.
- Keep completed copies in a secure, accessible place and tell an appropriate trusted person where to find them.
Keep the completed sheet private
The printable is a place to organize information, not a medical order or treatment plan. Do not upload a completed copy to public websites. Review it when contact details or information changes, and follow the instructions of the professionals responsible for care.
Printing tips
The PDF is formatted for US Letter paper (8.5 × 11 inches). Print in portrait orientation and use the print preview to check the margins. For A4 paper, select Fit to printable area and check that the entire page is visible. Save the PNG if you need an image file. Print a test copy before making multiple copies.
Frequently asked question
Is the PDF fillable on screen?
This version is a static printable form for handwriting. It does not have interactive PDF form fields.