My Health Information Patient Package
Four page printable PDF designed to help you organize your critical health information. Can be used by older adults to improve health literacy or by therapists as intake paperwork and as an educational tool. Print and write-in or use as fillable PDF. First page has sections for Medications (Daily and PRN with instructions for name of medication, dosage, time and why you take it); second page is current and past medical history, with area for diagnosis, responsible physician and action plan; third page for allergies, precautions and dietary considerations; and fourth page is for identifying HCP, caregiver contacts, heath care team and advanced directives.
Four page printable PDF designed to help you organize your critical health information. Can be used by older adults to improve health literacy or by therapists as intake paperwork and as an educational tool. Print and write-in or use as fillable PDF. First page has sections for Medications (Daily and PRN with instructions for name of medication, dosage, time and why you take it); second page is current and past medical history, with area for diagnosis, responsible physician and action plan; third page for allergies, precautions and dietary considerations; and fourth page is for identifying HCP, caregiver contacts, heath care team and advanced directives.
Four page printable PDF designed to help you organize your critical health information. Can be used by older adults to improve health literacy or by therapists as intake paperwork and as an educational tool. Print and write-in or use as fillable PDF. First page has sections for Medications (Daily and PRN with instructions for name of medication, dosage, time and why you take it); second page is current and past medical history, with area for diagnosis, responsible physician and action plan; third page for allergies, precautions and dietary considerations; and fourth page is for identifying HCP, caregiver contacts, heath care team and advanced directives.