Emergency Health Information Form

This free, downloadable document can be used as an example for creating a personal health history in the event a nonspeaking individual must receive emergency health care without their communication partner present. It was designed for use specific to the COVID-19 pandemic, since the unique circumstances might require separation of guardians, parents, or other caregivers from the nonspeaking person in need of medical care.

Your completed document should not exceed two pages of information, and that it is printed double-sided to prevent separation of pages. Make two copies and keep them in an accessible location near a main entry point of your home.

It is being offered in .doc format so that you can replace the existing text with your own. If you require this file in another format, please email contact@spellerslearn.com.