Your name, address, home and cellular phone number, email address
Medical Insurance information: note your insurance information with your ID numbers and phone numbers. If you have long term care insurance include that information also.
Prescription Insurance: company name, phone number, Policy #
Prescription Medications. List all of the medication you take. Write the names exactly as they are on your medications bottles. Note the dosage, times you take the medications and the date you started taking the medication as well as the reason for taking it
Note all of your health, dental and vision conditions including date of onset
Note any and all surgeries you have had. Including the date/year of the surgery, the surgeon’s name, the reason for surgery
If you are a snowbird, list the doctors whom you see in your hometown as well as the providers whom you visit when you are at your vacation home. The document allows your physicians to communicate with each other as needed.
List any allergies to drugs, food and environmental allergies.
Hospital where you would be admitted. Include the address and phone number.
Rehabilitation centers/facilities you are currently using or have used in the past. Include the address and phone number
Urgent Care Centers you have used. Include the address and phone number
Laboratories, where you get your blood work is done. Include the name, address and phone number
Facilities, where you get your diagnostic testing done. Include the name, address and phone number
Durable Medical Equipment being used, such as a walker, cane, wheelchair and the company where you have obtained the equipment. Include the name, address and phone number
Miscellaneous information: For example, copy of the card the doctor gives you to show the location of implantable devices as well as the serial numbers that identify the devices. These cards have important information that physicians would want to have in case there is a problem with the device or implant. Examples of implantable devices are stents, pacemakers, joint replacements, etc.
If you have contacted with a professional healthcare advocate to assist you in navigating the healthcare system, include their name, phone number and email address.
Make a list of all of your financial information with your account numbers and directions on who do contact when needed.
Names, addresses, phone number and email of your Attorney, your Financial Planner, your Accountant, your Bank and other financial institutions where you have accounts. These could include retirement accounts.
Your place of Worship. Many people want their names placed on a prayer list or have someone from the place of worship to visit them if you are housebound.
If you have made pre-arrangements with a Funeral Director, include the name, address and phone number.
If you have a description of how you want your funeral planned out, include that document so you can make sure your wishes can be implemented. Items to include could be your favorite scripture passages, music you like and people you want to make sure attend and what you want them to do.
A digital copy should be kept on a flash drive and be kept your wallet as well as saved on your person’s computer. Having the document on your computer allows you to update the document as your health history changes.