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Blank File Of Life PDF Form

The File Of Life form is a vital document designed to keep your essential medical information organized and accessible in case of an emergency. It includes details about your medications, medical history, and emergency contacts, ensuring that first responders have the information they need to provide appropriate care. To protect yourself and your loved ones, consider filling out this form by clicking the button below.

Article Guide

The File of Life form serves as a crucial tool for individuals to communicate essential medical information during emergencies. This form includes a comprehensive list of medications, both prescription and over-the-counter, that a person is currently taking. Users are encouraged to detail the frequency and purpose of each medication, ensuring that emergency responders have access to vital health data. Additionally, the form collects emergency medical information such as personal details, primary care physician contacts, and insurance information. It also prompts users to identify their emergency contacts, which can be critical in urgent situations. Furthermore, the File of Life includes sections for medical conditions, recent surgeries, and allergies, allowing for a holistic view of a person's health status. Regular updates to the form are essential, particularly after any changes in medication or medical history. To ensure accessibility, individuals should keep a copy of the form in a magnetic packet on their refrigerator and another in their wallet or purse. This proactive approach can significantly enhance the quality of care received during emergencies.

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LIST ALL MEDICINES YOU

ARE CURRENTLY TAKING

Please list prescriptions and over-the-counter medications (ex: aspirin, antacids) and herbals (ex: ginseng, ginkgo).

Make sure you include medications that you are taking routinely

and “as needed.”

Name of prescription,	How Often	Reason
Over-the-counter medication,	How Often	Reason
Over-the-counter medication,	You Take	For Taking
vitamins/supplements & dose	You Take	For Taking
vitamins/supplements & dose

EMERGENCY MEDICAL INFORMATION

In cooperation with: Sussex County Sheriff’s Dept.,

Sussex County Senior Services, Local Vol. Fire

and Ambulance Companies, & Delaware State Police

(Use your computer to complete this section )

Date Updated:

Name:

Address:

Sex: Male / Female

Date of Birth:

Primary Care Doctor:

Phone #:

Preferred Pharmacy:

Phone #:

Medical Insurance Co.:

Policy #:

Other Medical Insurance:

Policy #:

Medicare / Medicaid:

Policy #:

Living Will: Yes / No

Health Care Power of Attorney: Yes / No

EMERGENCY CONTACTS

Name: Phone #:

Address:

Name:				Phone #:

Address:

MEDICAL DATA

Recent Surgeries/Hospitalizations:		Date:

Update this form whenever you have a change of medication or medical history.

Keep a copy of this form in your File of Life magnetic packet, which should be placed on your refrigerator. A copy of this form also should be kept in your wallet or purse in case of emergency. For additional copies of this form or to receive a new magnetic packet, please contact Beebe Medical Center’s Community Relations Dept. at 302-645-3468. This form can also be obtained and filled out online at www.beebemed.org.

(over)

Tear on perforation and insert your updated File of Life form

into your magnetic pocket.

MEDICAL CONDITIONS

(check all that apply)

HEART DISEASE		LUNG DISEASE		KIDNEY
				DISEASE
	CHF/Heart Failure		COPD/Emphysema		Failure

	High Blood Pressure		Asthma		Insufficiency
	High Blood Pressure		Asthma		Insufficiency

	Low Blood Pressure		Fibrosis		Dialysis
	High Cholesterol		Pneumonia		Kidney Stones
	High Cholesterol		Pneumonia		Kidney Stones

	Irregular Heart Beat		Bronchitis		Infections
	Irregular Heart Beat		Bronchitis		Infections
	Pacemaker		Shortness of Breath

	Heart Attack		Coughing



	Angina or Chest Pain		Lung Pain



	Heart Surgery/


	ByPass/Stent
	ByPass/Stent

STOMACH	NEUROLOGICAL	MALIGNANCY/
DISEASE	DISEASE	CANCER
Bowel Obstruction	Stroke	Lung
Bleeding	Bleeding in Brain	Liver
Diverticulitis	Seizures	Breast
Hiatal Hernia	Multiple Sclerosis	Stomach

GERD/Reflux	Parkinson	Leukemia
Diarrhea	Headaches	Colon

Blood in Stools	Alzheimers or	Skin
Blood in Stools	Alzheimers or	Skin

	Memory Loss	Other:
ENDOCRINE	OTHER
DISEASE
Diabetes	Arthritis	Vision
Thyroid:	Back Problem	Problems
High	HIV	Other
Low	Sickle Cell

Weight Gain

Weight Loss

ALLERGIES

(check all that apply)

Aspirin	Laytex	Tetracycline

Barbiturates	Lidocaine	X-Ray Dye
Barbiturates	Lidocaine	X-Ray Dye

Codeine	Morphine	No Known Allergy



Demerol	Novocain	Other:
Demerol	Novocain	Other:
Insect Stings	Penicillin

Horse Serum or	Sulfa


Vaccines

Update this form whenever you have a change of medication or medical history.

to receive a new magnetic packet, please contact Beebe Medical Center’s Community Relations Dept. at 302-645-3468. This form can also be obtained and filled out online at www.beebemed.org.

UNIVERSAL MEDICATION FORM

(Use pencil on this form to allow for easy changing)

Date Updated:

Name:

Address:

Sex: Male / Female	Date of Birth:

Primary Care Doctor:

Phone #:

Preferred Pharmacy:

Phone #:

Medical Insurance Co.:

Policy #:

Other Medical Insurance:

Policy #:

Medicare / Medicaid:

Policy #:

MEDICINE ALLERGIES/REACTIONS (describe reaction)

Drug:Reaction:

➤ PDF File

Form Specifications

Fact Name	Description
Purpose	The File of Life form is designed to provide essential medical information in emergencies.
Medication List	Users must list all current medications, including prescriptions, over-the-counter drugs, and supplements.
Emergency Contacts	The form requires users to include emergency contacts with names and phone numbers.
Medical Conditions	Users can check all relevant medical conditions, such as heart disease or diabetes.
Allergies	The form includes a section for users to list known allergies and reactions.
Update Frequency	It is important to update the form whenever there are changes in medication or medical history.
Storage	The completed form should be kept in a magnetic packet on the refrigerator and in a wallet or purse.
Accessing the Form	The File of Life form can be obtained online at www.beebemed.org or by contacting Beebe Medical Center.
Governing Law	In Delaware, the File of Life program operates under local health regulations and community service laws.

File Of Life: Usage Guidelines

Completing the File Of Life form is essential for ensuring that your medical information is readily available in case of an emergency. Follow these steps carefully to fill out the form accurately.

Gather your information: Collect details about your medications, medical history, emergency contacts, and insurance information.
Fill out the medication section: List all medicines you are currently taking, including prescriptions, over-the-counter medications, and herbal supplements. Include the name of the medication, how often you take it, and the reason for taking it.
Update your personal information: Enter your name, address, sex, date of birth, primary care doctor’s name, phone number, preferred pharmacy, and medical insurance details.
Provide emergency contacts: List at least two emergency contacts with their names, phone numbers, and addresses.
Detail your medical data: Note any recent surgeries or hospitalizations, including the dates.
Check medical conditions: Indicate any medical conditions that apply to you by checking the appropriate boxes.
List allergies: Check all allergies that apply to you, including medications and other substances.
Complete the universal medication form: Use a pencil to fill out this section, allowing for easy updates. Include the date, your name, address, sex, date of birth, primary care doctor, phone number, and insurance information.
Review the form: Ensure all information is accurate and complete before finalizing.
Store the form: Place a copy in the File of Life magnetic packet on your refrigerator and keep another copy in your wallet or purse.

Once you have completed the form, it is crucial to update it whenever there is a change in your medications or medical history. Keeping this information current can be vital in emergencies.

Your Questions, Answered

What is the File of Life form?

The File of Life form is a vital document designed to keep important medical information readily available during emergencies. It includes details about your medications, medical history, emergency contacts, and insurance information. This form is typically kept in a magnetic packet on your refrigerator, ensuring that first responders can easily access it when needed.

How do I fill out the File of Life form?

To complete the File of Life form, you will need to provide information about your current medications, medical conditions, and emergency contacts. Start by listing all prescriptions, over-the-counter medications, and supplements you take, along with their dosages and reasons for taking them. Next, fill in your personal details, including your name, address, date of birth, and insurance information. Finally, include any emergency contacts and medical history, such as recent surgeries or hospitalizations.

Why is it important to keep the File of Life form updated?

Keeping the File of Life form updated is crucial because your medical information can change frequently. Changes in medications, health conditions, or emergency contacts should be reflected on the form to ensure that first responders have the most accurate and relevant information during an emergency. Regular updates can save time and potentially save lives.

Where should I keep my File of Life form?

The completed File of Life form should be placed in a magnetic packet on your refrigerator. This location is recommended because emergency responders often check the fridge for important medical information. Additionally, it’s wise to keep a copy of the form in your wallet or purse for easy access in case of emergencies outside your home.

Who should I contact if I need additional copies of the File of Life form?

If you require more copies of the File of Life form or need a new magnetic packet, you can contact Beebe Medical Center’s Community Relations Department at 302-645-3468. They can provide you with additional resources and assistance.

What should I do if my medical conditions change?

If your medical conditions change, it’s important to update your File of Life form immediately. This includes adding new medications, changing dosages, or noting any new diagnoses. Keeping this information current ensures that healthcare providers have the most accurate data to work with during emergencies.

Can I fill out the File of Life form online?

Yes, you can fill out the File of Life form online. Visit www.beebemed.org to access the form. This feature allows for easy updates and ensures that you have a digital copy available if needed.

What kind of medical data is included in the File of Life form?

The File of Life form includes a variety of medical data such as recent surgeries, hospitalizations, allergies, and chronic conditions. It also contains information about your primary care doctor, preferred pharmacy, and insurance details. This comprehensive data helps emergency responders understand your medical needs quickly.

Is there a cost associated with obtaining the File of Life form?

No, there is typically no cost associated with obtaining the File of Life form. It is provided as a community service to help individuals keep their medical information organized and accessible in emergencies. Contact Beebe Medical Center for more information on obtaining the form.

Common mistakes

Incompleteness: Failing to list all medications, including prescriptions, over-the-counter drugs, and herbal supplements can lead to serious medical errors. It is crucial to provide a comprehensive list.
Outdated Information: Not updating the form regularly can result in emergency responders having incorrect information. Always ensure the form reflects your current medications and medical history.
Missing Emergency Contacts: Omitting important contacts can hinder communication during an emergency. Always include at least two reliable contacts with their phone numbers and addresses.
Neglecting Medical Conditions: Not checking all applicable medical conditions can lead to inadequate treatment. Be thorough when indicating any health issues.
Ignoring Allergies: Failing to disclose allergies can pose significant risks during medical emergencies. Ensure that all known allergies are clearly marked on the form.
Not Keeping Copies Accessible: Keeping only one copy of the form can be a mistake. Always have a copy in your refrigerator and another in your wallet or purse.
Incorrect Contact Information: Providing inaccurate phone numbers or addresses for your primary care doctor or pharmacy can delay necessary medical care. Double-check this information before submitting the form.
Forgetting to Indicate Living Will Status: Not specifying whether you have a living will can complicate medical decisions in emergencies. Clearly state your preferences.
Using Inappropriate Writing Tools: Filling out the form with pen instead of pencil can make updates difficult. Use pencil for easy corrections as needed.

Documents used along the form

The File of Life form is a crucial document for individuals seeking to provide essential medical information in emergencies. It ensures that first responders have access to vital details about medications, medical conditions, and emergency contacts. Alongside this form, several other documents can enhance preparedness and facilitate effective communication during critical situations.

Universal Medication Form: This form provides a comprehensive overview of all medications, including prescriptions and over-the-counter drugs. It allows individuals to list any allergies or reactions to medications, ensuring that healthcare providers have a complete picture of a patient’s medication history.
Living Will: A living will outlines an individual’s preferences regarding medical treatment in situations where they may not be able to communicate their wishes. This document is particularly important for end-of-life care decisions and helps guide healthcare providers and family members in respecting a person's choices.
Health Care Power of Attorney: This document designates a trusted person to make medical decisions on behalf of an individual if they become incapacitated. It ensures that someone who understands the individual’s values and preferences can advocate for their healthcare needs.
Emergency Contact List: This simple yet vital document contains names and phone numbers of individuals to contact in case of an emergency. It can include family members, friends, or other trusted individuals who can provide support or information about the patient’s medical history.
Medication List: Similar to the Universal Medication Form, this list focuses specifically on all medications an individual is currently taking. It is useful for quick reference and can help prevent medication errors during emergency situations.

Having these documents readily available can significantly improve the quality of care received during emergencies. It is advisable to keep them organized and accessible, ensuring that both individuals and their loved ones are prepared for any unforeseen medical events.

Similar forms

The File Of Life form is an essential document that provides critical medical information during emergencies. It shares similarities with several other important documents designed to ensure that individuals receive appropriate care. Here are five documents that are similar to the File Of Life form:

Universal Medication Form: Like the File Of Life form, the Universal Medication Form collects vital information about medications, allergies, and medical history. Both forms emphasize the need for accurate and up-to-date data to assist healthcare providers during emergencies.
Emergency Medical Information Card: This card serves a similar purpose by summarizing key medical details, including allergies and current medications. It is typically small enough to carry in a wallet, ensuring that crucial information is readily available when needed.
Living Will: While primarily focused on end-of-life decisions, a Living Will can be similar in that it communicates personal medical preferences. Both documents aim to guide healthcare professionals in making decisions that align with an individual’s wishes.
Health Care Power of Attorney: This document designates someone to make medical decisions on your behalf if you are unable to do so. Like the File Of Life form, it ensures that your medical preferences are respected and followed in emergencies.
Patient Health History Form: This form provides a comprehensive overview of an individual’s health background, including past surgeries and chronic conditions. Similar to the File Of Life form, it is crucial for healthcare providers to understand a patient’s medical history to deliver effective care.

Each of these documents plays a vital role in ensuring that individuals receive the right care during emergencies, just like the File Of Life form. Keeping them updated and accessible can make a significant difference in critical situations.

Dos and Don'ts

When filling out the File Of Life form, it is essential to provide accurate and complete information. Below are guidelines on what to do and what to avoid during this process.

Do list all medications you are currently taking, including prescriptions, over-the-counter drugs, and herbal supplements.
Do include the frequency of each medication and the reasons for taking them.
Do update the form whenever there are changes in your medications or medical history.
Do keep a copy of the form in your File of Life magnetic packet on your refrigerator.
Do also carry a copy in your wallet or purse for emergencies.

Don't leave out any medications, even those taken occasionally or “as needed.”
Don't use unclear abbreviations that may confuse emergency responders.
Don't forget to include emergency contacts and their information.
Don't fill out the form in pen; use a pencil for easy updates.
Don't neglect to indicate any allergies or reactions to medications.

Misconceptions

Understanding the File of Life form is crucial for ensuring that medical responders have immediate access to your vital health information during emergencies. However, several misconceptions can lead to confusion about its purpose and usage. Here are nine common misconceptions:

It is only for elderly individuals. Many believe the File of Life form is exclusively for seniors. In reality, anyone with medical conditions or taking medications should have this form, regardless of age.
It only needs to be filled out once. Some people think that completing the form is a one-time task. However, it is essential to update the form whenever there are changes in medications, medical history, or emergency contacts.
It is not necessary if I have a medical alert bracelet. While medical alert bracelets provide important information, the File of Life form offers a comprehensive overview of your health history and medications, which is invaluable in emergencies.
My family knows my medical history, so I don’t need the form. Even if family members are familiar with your health details, having a documented form ensures that critical information is available to emergency responders who may not know you.
It is only for people with serious medical conditions. This form is beneficial for anyone, including those with minor health issues or allergies, as it can help prevent complications during emergencies.
I can keep the form on my phone. While digital records are useful, keeping a physical copy of the File of Life form on your refrigerator is crucial. Emergency responders often look for it in that location.
It is complicated to fill out. The form is designed to be straightforward. It provides clear sections for medications, allergies, and emergency contacts, making it easy to complete.
Once I fill it out, I don’t need to worry about it. Regular updates are necessary. As your health changes or new medications are prescribed, keeping the form current is vital for accurate medical care.
I can’t get a new form easily. Many people think that obtaining a new File of Life form is difficult. In fact, additional copies can be requested from local health organizations or downloaded online.

By addressing these misconceptions, individuals can better understand the importance of the File of Life form and ensure they are prepared for any medical emergencies.

Key takeaways

Filling out and using the File Of Life form is crucial for ensuring that emergency responders have immediate access to vital medical information. Here are key takeaways about this important document:

Comprehensive Medication List: Include all medications, both prescription and over-the-counter, as well as herbal supplements. This helps medical personnel understand your current health status.
Emergency Medical Information: Provide essential personal details such as your name, address, date of birth, and contact information for your primary care doctor and preferred pharmacy.
Update Regularly: It is important to update the form whenever there is a change in your medications or medical history. This ensures that the information remains accurate and useful in emergencies.
Emergency Contacts: List at least two emergency contacts, including their names, phone numbers, and addresses. This allows responders to reach out to someone who knows your medical history.
Medical Conditions: Check all relevant medical conditions on the form. This information can significantly impact treatment decisions during an emergency.
Allergies: Clearly indicate any known allergies and reactions to medications. This information is critical to avoid administering harmful substances.
Accessibility: Keep a copy of the form in your File of Life magnetic packet on your refrigerator and another copy in your wallet or purse. This ensures that it is easily accessible when needed.

For additional copies or to obtain a new magnetic packet, contact Beebe Medical Center’s Community Relations Department at 302-645-3468 or visit their website at www.beebemed.org.