"Tracks To Tomorrow" Medical Form for Everyone

FrenchieXJ

Expedition Leader
This will be a standard forum we will use on every event. This will have a link in each Posting Thread to the form. This can be used by all of us all of the time. It may save your life. If it does not you will not know about it.

Why do we need this? We never plan our day with a emergency or accident in it, but it can happen. If your in a group of ours or some other group. We do not know all of the information about you if you were to get hurt. Having this written down and with you in a emergency where it is available for first responder's and medical personal, this paper may be your life saver. If your in a accident on the road some place on your own and can not communicate with the "First Responders", doctors. When your unable to communicate the people who are there will look for information about you. This could be drivers license, vehicle registration, insurance card or similar type of paperwork. They generally will check your glove box or console.

Plain and simple! If you do not want to have this for yourself, that is fine for you. We do not need to worry about you, If you do not want to have it, Stay Home! This is not a request it is a "TTT" rule. If you do not like this then do not ask to join the group. Straight to the point! Something happens to you that with proper knowledge could have been avoided you make us feel bad. All because you were to lazy to share the information with people who you then need to depend on for help. Why should we care about you when you do not care about you! The trouble is we do care about you. So do it for us, even if you do not want to do it for yourself!

Your personal medical information is yours and we respect that. For this reason we request that your medical information be put in a sealed envelope. Only in a emergency will we get access to it. It is your responsibility to inform more then one person in the group where it is located, in case your unable to get the location to us in a emergency.

For your contacts; They need to be notified that they are on your contact list. They need to know that in a emergency that they will be contacted. Not time for them to get a surprise of being on your list. I did not have your Social Security/Medicare numbers added to the list. This is actually important for the people who are on Medicare. I do have this information with my additional insurance card. This may be important for your contact people to have in the information that you leave with them. If the need comes to where you need to have this information they will have access to it for you.

Copy from below the line. Fill it out, put it in the envelope and seal it, Label it with your “Name” and “Medical Information” on the outside of the envelope.

Unless the information changes, If you do this once you can always have it in your vehicle. Only when the information changes do you need to update it. It is good to review it prior to any trip or if any changes occur.

This is always good to have in your vehicle all of the times. You could be in a accident around your town and this could save your life!
-------------------------------------------------------------------------------------------------------------------------------
T.T.T. Medical Information Form
Last Updated and checked on ______ / ______ / ______
Your Personal medical information
Name:
Date of birth:
Age:

Blood type:

Address:

Phone(s):

Vehicle description: Lic. Plate #
Year Make, model and color
Identification description

Emergency Contact Information
First person to contact
Name:
Relationship
Address:

Phone(s):
Email:

Second person to contact
Name:
Relationship
Address:

Phone(s):
Email:

Third person to contact
Name:
Relationship
Address:

Phone:
Email(s):

Prescribed Medications you take;
Name:
Dosage:
Frequency:

Name:
Dosage:
Frequency:

Name:
Dosage:
Frequency:

Name:
Dosage:
Frequency:

Name:
Dosage:
Frequency:

Name:
Dosage:
Frequency:

Name:
Dosage:
Frequency:

Name:
Dosage:
Frequency:

Your Doctors
Name:
Specialty:
Phone:

Name:
Specialty:
Phone:

Name:
Specialty:
Phone:

Name:
Specialty:
Phone:

NON-Prescribed Medications you take

Name and dose:

Name and dose:

Name and dose:

Relevant Medical Issues & dates
1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Your Allergies to;
Medications:

Foods:

Animals:

Plants:

Recreational drugs you take;

Health Insurance Primary
Company Plan Name:

Phone Number

Member Number:

Other Numbers:

Health Insurance Secondary
Company / Group Plan Name:

Phone Number

Member Number:

Other Numbers:

Do you have a D. N. R. Form? Filled out and on file at:

If you need more room to list things write “continued on back side” in the location on the front side. Then put it on the additional information on the back side.
On the reverse side you can provide any additional information that will be used to allow the best treatment, if your unable to communicate. The more information that is given the more precise the treatment can be.

Medical Personal check back side of all papers for additional information.

As a suggestion, if you are traveling to different countries. You can use your computer and translate your information in the language of that country. Just saying that this is about your life, you do what every you want.

Tracks To Tomorrow
 
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FrenchieXJ

Expedition Leader
I got a couple of PM's about the why you should have this paper with the information on it.
I made some changes to the #2 and #3 paragraphs of this thread. Go back and re-read them again if you have any questions.

Also was mentioned about privacy of your information. If some one broke into your vehicle they could have access to some personal information about you.
I had considered this when I made out the form. I did not have your Social Security/Medicare numbers added to the list. This is actually important for the people who are on Medicare. I do have this information with my additional insurance card. This may be important for your contact people to have in the information that you leave with them. If the need comes to where you need to have this information they will have access to it for you.

I want to thank the people who pointed out some ways to improve the information and the why. This is just us helping one another.

Thank you,
Da Frenchman
 

FrenchieXJ

Expedition Leader
Hi Everyone,

I have some good news! In looking at my threads. The number of views on this thread is growing! I am not saying that this is a numbers game. I am pleased that there are many people reading this thread. I hope that this will translate into people filling out the information and having the information with them. Just in Case!

This is important information that could save your life. Growing up my mother would say; You do this or that, it is important because ......... . As most kids, I did not do it. In the end my mother would say I told you to do that! Whether or not, we will admit to it,"Mothers and Fathers" generaly know what they are talking about.

Do not put off to tomorrow what you should do today! Tomorrow may be one day to late!

I hope that you will never need to have the need for this information used for yourself.

Thank you,
Da Frenchman
 
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