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Home Safety Emergency Plan

 
Special Needs, Health Care Providers
Special Needs & Disabilities
  • Carry a health information card if you have special needs.
  • Evaluate your capacities, limitations, needs and surroundings.
  • Determine type of help you may need during an emergency.
  • List information: doctors, allergies, medications, disabilities, equipment.
  • Keep medication and supplies on hand for at least 7 days.
   
 Use this space to describe your special needs.
 
 
 
 
 
 
Health Care Providers
 Name  Special Needs  Health Provider  Phone, Email
 
 
 
   
Medication List
 Name
 
 Medication
 /Dosage
 Doctor
 Prescription #
 Reason Taking
 Start/End Date
 
 
  • Be cautious of writing names of narcotics and other drugs that could be stolen.