Empowered Patient Online Toolkit

Tab 1: Very Important Documents

The first tab of your binder should include your personal information and any documents you will need to access quickly in an emergency. The templates in this section will help you organize your medical contacts, emergency contacts, and important information for emergency and non-emergency medical personnel.

Patient Medical Summary

Use this document to track your personal information and emergency contacts, and as a brief summary of your most important medications and medical information. Update this document quarterly. Include any critical health information at the top of the sheet, including, “Do Not Stop Pump,” “On Sildenafil - No Nitrates” and/or “Takes Coumadin.” Make copies for family members and carry a copy with you at all times in case of emergency.

Emergency Room Preparedness Checklist

Preparing an emergency kit is the best way to ensure you have your medications and medical supplies ready at a moment’s notice. This checklist includes some "must-haves," but be sure to consult with your doctor, nurse and pharmacist to ensure that you have all the items you need on hand.

Medication Log

This tab should always include a current list of your medications. Use this log to record everything you take, both prescribed and over the counter medications. Medicines that you have recently stopped taking should remain on your list. Use multiple sheets if necessary. Note why each medication is being taken and the reason stopped in the notes column. Be sure to update your list every time you start or stop a new medicine. You can also attach any drug information given to you by your medical team or pharmacy to this sheet.

Medical Contact List

Compile a complete list of all your doctors and healthcare providers, along with their specialties and contact information. Share this list with your primary care doctor and specialists as necessary. Doctors should send each other up-to-date information about appointments or any tests you have had.

Insurance Form

Use this document to keep a current record of your insurance information.

Next Tab

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The information provided on the PHA website is provided for general information only. It is not intended as legal, medical or other professional advice, and should not be relied upon as a substitute for consultations with qualified professionals who are familiar with your individual needs. PHA does not endorse or recommend any commercial products or services.

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