TRAVEL GUIDE

Emergency Information Form: Traveling With Children  
Victoria Irwin
CONSUMER HEALTH INTERACTIVE

This document will help you in an emergency. Print out two copies and fill in the blanks. Keep one copy with you, and give one to your spouse or traveling companion. Also, be sure to pack your child's prescription medicines (and bring them along if you have to take your child to a doctor or an emergency room) and a first-aid kit so you can cope with minor medical problems.

My child's name:_________________________
Age:__________
Height and weight:________________________________________
Address:_______________________________________________________________
Phone:______________________
Social security number:____________________________________

   Doctors

My child's doctor at home:_____________________________________
Phone:_____________________

If possible, get a referral from your pediatrician before you leave:_____________________

Phone:____________________
Address:_______________________________________________________________

   My child's health insurance

Be sure to take health insurance ID cards with you, and before you depart, check your policy or call your insurance company to check on coverage when you're away from home.

Company name:________________________________________
Policy number:_________________________
Phone:_______________________

   Emergency contacts

Name:_________________________________________
Phone:_________________________
Relationship:_________________________

Name:_________________________________________
Phone:_________________________
Relationship:_________________________

   My child's medical history

Preexisting conditions:_____________________________________________________
Allergies to medicines:_____________________________________________________
Medications (prescription and nonprescription; note exact names and dosages):_______________________________________________________________

Immunization history (attach a vaccination record to this sheet):_________________________________________________________________
Previous hospitalizations, surgeries:_______________________________________________________________
Comments:_____________________________________________________________

   For more information:

Call Ask-a-Nurse, a 24-hour service that locates nurses in many states, at (800) 535-1111.

HotelDocs, a network of physicians in 150 U.S. cities, can get a doctor to your hotel within 60 minutes. The cost is $150 to $195 per visit, depending on the time of day; call (800) 468-3537.

References

Robert H. Pantell M.D., James F. Fries M.D., Donald M. Vickery M.D., Taking Care of Your Child: A Parent's Illustrated Guide to Complete Medical Care. Perseus Books Publishing, L.L.C.: 1999.

Reviewed by Paul C. Young, M.D., associate professor of pediatrics at the University of Utah School of Medicine, in Salt Lake City , Utah .


First published July 19, 1999
Last updated December 11, 2002
Copyright © 1999 Consumer Health Interactive