In the event of calling 9-1-1 for emergency medical assistance, the form below can help provide emergency medical responders with vital information to assist them in their evaluation, both on arrival to your home and enroute to the hospital.
When this form accompanies the patient to the hospital, it can help serve as a valuable resource for equipping emergency center personnel with crucial details.
To help lessen the stress associated with a medical emergency, complete the information on the reverse side of this form for each household member and place it in a highly visible location, such as the refrigerator door or near the front entrance. Remember to create extra copies in preparation for any unforeseen circumstances and to include them in a go-bag.
Additional forms are available at the OVA administrative office.
This document was prepared by Meet Your Neighbors and the Oakmont Emergency Preparedness Committee.
MEDICAL-EMERGENCY-USE-FORM