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Medical Summary Card

When a pregnant woman first visits her obstetrician detailed medical history is taken along with very important lab work is done. For most this can be very simple
but for others a complicated history is very important to pass along.
This information is vital for you, when traveling, if you relocate, or even everyday because you never know when an emergency may occur.
You may not be able to give a history at that time
. By having a copy of your current prenatal information with you could save you time in treatment,
save you from having unnecessary lab work, possibly even your baby's life. Below is a printable card form. By Jean Borgia RN

Medical Summary Card
 During pregnancy, its often a good idea to carry your basic medical information. Use this form to generate a medical summary card that you can print and keep with you in case that you need medical aid.
About You:
First Name:
Last Name:
Address 1:
Address 2:
Telephone
Alternate Phone #:
Due Date:
 / /
Birthday:
 / /
Blood Type:
Medications:
Allergies:
 
Hola
About Your Insurance:
Provider:
Provider Phone:
Plan:
Policy #:
Hola
Emergency Contact Information:
Name:
Relationship to you:
Telephone #:
Alternate Telephone #:
Hola
Your Risks:
Select all that apply:
Common risks:

Other Risks:
Medical History:
Enter dates for the following:
C-Sections:
Medical Miscarriages:
Preterm Deliveries:
Toxemia/Preeclampsia:
Other Medical: