Printable
Printable emergency information sheet for an aging parent
One page with the information family and first responders need. Print it, fill it in by hand, and keep copies on the fridge, with a neighbor and in each family member’s files.
Updated October 2026. Nothing on this page collects or sends what you write: it is a blank sheet for paper.
Emergency information
Keep a copy on the fridge, with a neighbor, and in each family member’s files. Review every few months and after any fall, hospital stay or change in health.
About me
Full name
Date of birth
Home address
Phone
Language
Emergency contacts (in the order to call)
Name
Relationship
Phone
Health
Conditions
Allergies
Blood type (if known)
Uses (glasses, hearing aid, walker, oxygen)
Medications
Medication and dose
When taken
Prescribed for
Doctors and pharmacy
Primary doctor
Specialist
Pharmacy
Preferred hospital
Insurance
Plan name
Member ID
Phone
If help needs to get in
Neighbor with a key
Neighbor phone
Spare key or lockbox location
Pets or other notes
Updated on ______ by ______ | This sheet is not a legal or medical document. Keep legal papers (such as a healthcare proxy) with the family’s other important documents.
How to use it
- Fill it in together with your parent, in pen, in plain handwriting.
- Make copies: the fridge, a neighbor, each sibling, and a photo on your own phone.
- Add the same information to the phone as emergency contacts and a medical ID. See how to set up emergency contacts and a medical ID.
- Review it every few months, and after any hospital stay.
- Only write what your parent is comfortable sharing. You can leave lines blank.
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