Security

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Information Includes:
General
 Name – Address –Telephone # - Email
 Birthdate - Gender – Height – Weight
 Photo
 Language – Religion
 Diabetic – Yes or No
 Medical Insurance Information
Allergies
 Food
 Drug
 Contact
 Other
Medical Conditions
 Type
 Current or Past
Medications
 Name
 Dosage
 Frequency
 Pharmacy – Name – Telephone – Script #
 Prescribing Doctor
Surgeries
 Type
 Date
Implants/Devices
 Name – Type
 Date
 Serial #
Vaccinations
 Name – Type
 Date
Medical Providers
 Name – Telephone #
 Specialty
Emergency Contacts
 Name – Address – Telephone # - Email
 Relationship