Patient Info

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Click or drag a file to this area to upload.
Example: Strawberries, Penicillin
Do you wish to be an organ donor?
Are you on special diet? Keto? Mediterranean? Gluten Free? Or another diet.
Cane, Wheelchair, Braces, Etc.

Emergency Info

Example: Strawberries, Penicillin

Current Diagnoses

Treatment Protocols

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Click or drag a file to this area to upload.
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.

Insurance Information

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Click or drag a file to this area to upload.

Known Medical Conditions

Example: Stawberries, Penicillin

Symptoms to Watch For

Current Medications

List your medications, your dosage, how often and time of day the medication(s) are taken

Vaccinations

Emergency Contact Info

Treating Physicians

Previous Surgeries/Implants/Devices

Glasses and Contacts

Recent Test Results

Family History

Example: Father / High Blood Pressure

Other Additional Information

Example: • Carries royal blue NorthFace backpack • Avid bike rider • Wears Apple watch • Cellphone is an iPhone 13

Notes

File Repository

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Click or drag a file to this area to upload.
Click or drag a file to this area to upload.
Select a 4 digit PIN #
By Default: Your Name, Picture, Birthdate, My Rare ID, and PIN # will appear. You can include up to 5 additional items from your profile.
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