In Case of Emergency

Are you prepared for a situation requiring emergency health services or a hospital admission?

How easily could paramedics or hospital staff get important information including:

  • your identity
  • your health status
  • your medications
  • your life-threatening allergies
  • your health care wishes
  • who should be contacted in an emergency
  • who can speak for you when you can’t speak for yourself

It is critical to have accurate, up-to-date information documents that can be easily located when minutes matter.

Patient Pathways has developed a comprehensive form to capture all important information.

    1. Click on the form image to open the In Case of Emergency Form in a new tab.
      NOTE: If you have any difficulties with the PDF form, save the PDF form to your computer, then open it with a current version of Adobe Reader.
    2. Save the completed form to your computer. Keep saving as you go along. Name the file something easy to find – like ICE_Smith, Jane.
    3. Complete and save a copy of the form for each member of your household.
    4. Print one copy of page 5 to use as a cover sheet.
    5. Print the completed forms [pages 6 – 13] for each person.
    6. Put the cover sheet on top. Clip or staple the related forms listed on page 1 to the completed ICE form for each person.
    7. Place all of the forms in a zippered plastic envelope and use magnets to stick it to the outside of  your fridge. You could also put it in your fridge or attached freezer. Emergency personnel are trained to find emergency information there.
    8. Give copies of the forms to the people who will need them if they have to speak for you when you can’t, and manage your affairs if you are not able to.
    9. Update the form as needed according to the instructions.
    10. Take a copy of the form with you to medical appointments to help with discussions with your healthcare team.