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Health History Forms Aide Emergency Health Care Workers

New visitor restriction protocols due to the highly contagious nature of the COVID-19 virus and the inability to allow passengers during patient transport via ambulance can leave the public feeling uneasy and helpless if a loved one is in need of medical services.

To help empower families and encourage the sharing of accurate health history information, Lincoln Medical Center Ambulance Service and Lincoln Health System officials would like to urge everyone to complete a simple health history for each member of their family that can be handed off to medical professionals if services are needed.

The information that should be readily available for each member of your family includes the following:

  • Name
  • Address
  • Date of Birth
  • Emergency contact information
  • Family physician name and phone number
  • Medical history/listing of chronic conditions
  • Surgical history
  • Medication list

This information can be stored in individual zip-top bags in a safe place at home as well as in your personal vehicle so they can be handed off to an EMT or emergency room personnel if the need arises.

 

View Lincoln Health System’s easy to complete form here. 

 

lhs-health-history-form_4-3-2020

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