EMEREC01 Names and NumbersEMEREC02 ContactsEMEREC03 Medical Information
This required section givesthe names of the parents and/or guardians and dependents.It also includes emergencytelephone numbers. Press[Ctrl+F1] for moreinformation.This optional section givescare givers the names andaddresses of two emergencycontacts. Press [Ctrl+F1]for more information.This optional section includesinformation for the care giverregarding special instructionsand important medicalinformation. Press [Ctrl+F1]for more information.
This required section lists parents, guardians, and dependentsnames as well as emergency telephone numbers for physicians,hospitals, etc.Using the format MM/DD/YYYY, enter the date that this emergencyinformation document was created.Enter the name of the FIRST PARENT OR GUARDIAN for whom theEmergency Names and Numbers list is being created. Access theExpert Guide for more information.Enter the name of the SECOND PARENT OR GUARDIAN for whom theEmergency Names and Numbers list is being created.Enter the full name of the FIRST DEPENDENT for which this EmergencyName and Number list is being created. This information may beuseful if the care giver needs to provide information to anemergency contact.Enter the full name of the SECOND DEPENDENT for which this EmergencyName and Number list is being created. This information may beuseful if the care giver needs to provide information to anemergency contact.Enter the full name of the THIRD DEPENDENT for which this EmergencyName and Number list is being created. This information may beuseful if the care giver needs to provide information to anemergency contact.Enter the full name of the FOURTH DEPENDENT for which this EmergencyName and Number list is being created. This information may beuseful if the care giver needs to provide information to anemergency contact.Enter the full name of the FIFTH DEPENDENT for which this EmergencyName and Number list is being created. This information may beuseful if the care giver needs to provide information to anemergency contact.Enter the full name of the SIXTH DEPENDENT for which this EmergencyName and Number list is being created. This information may beuseful if the care giver needs to provide information to anemergency contact.Enter the full name of the SEVENTH DEPENDENT for which thisEmergency Name and Number list is being created. This informationmay be useful if the care giver needs to provide information to anemergency contact.Enter the full name of the EIGHTH DEPENDENT for which this EmergencyName and Number list is being created. This information may beuseful if the care giver needs to provide information to anemergency contact.Enter the full name of the NINTH DEPENDENT for which this EmergencyName and Number list is being created. This information may beuseful if the care giver needs to provide information to anemergency contact.Enter the full name of the TENTH DEPENDENT for which this EmergencyName and Number list is being created. This information may beuseful if the care giver needs to provide information to anemergency contact.Enter the phone number of your POISON INFORMATION center, includingthe area code. Many states have a toll free poison informationnumber which may be obtained from directory assistance or your localtelephone directory.Enter your family PHYSICIAN'S phone number, including the area code.Enter your local FIRE DEPARTMENT phone number, including the areacode.Enter your local POLICE telephone number, including the area code.Enter your local HOSPITAL telephone number, including the area code.Enter your local AMBULANCE phone number, including the area code.
This section is optional. Select it to include names and addressesfor emergency contacts.Enter the name of the first person that the care giver shouldcontact if there is an emergency or edit the information as desired.Enter the first contact person's street address or edit theinformation as desired.Enter the first contact person's extended street address or edit theinformation as desired.Enter the first contact person's city or edit the information asdesired.Enter the first contact person's state/province or edit theinformation as desired. Press [F8] to select a state from theselection box.Enter the first contact person's zip/postal code or edit theinformation as desired.Enter an X to include the first contact person's country, ifoutside the United States.Enter the first contact person's country or edit the informationas desired.Enter the first contact person's telephone number, including thearea code.Enter the relationship of the first contact person to the parent whois preparing this emergency information. For example, "brother","sister", "friend", "babysitter" or "grandmother". Press [F8] toselect a relationship from the selection box.Enter the name of the second person that the care giver shouldcontact if there is an emergency or edit the information as desired.Enter the second contact person's street address.Enter the second contact person's extended street address.Enter the second contact person's city.Enter the second contact person's state/province. Press [F8] toselect a state from the selection box.Enter the second contact person's zip code or postal code.Enter an X to include the second contact person's country, ifoutside the United States.Enter the second contact person's country.Enter the second contact person's telephone number, including thearea code.Enter the relationship of the second contact person to the parentwho is preparing this emergency information. For example,"brother", "sister", "friend", "babysitter" or "grandmother".Press [F8] to select a state from the selection box.
OPTIONAL MEDICAL INFORMATION (SECTION 3 OF 3) Special Conditions: Medications: Allergies: Specify any other information:
This section is optional. Select it to include special conditionsand important medical information.Enter any special conditions which the care giver should know. Forexample, any illnesses, physical problems, or special routines.Enter any special medications of which the care giver should beaware. For example, prescription medications, what to give forcolds, or headaches.Enter any allergies of which the care giver should be aware.Enter any additional information which the care giver should know.