8" x 10" $ 9.95 USD, 10" x 12" $ 13.95 USD
One Person, Multi-Person
$9.95 – $13.95
“Your Emergency Medical Info Kit made a difference for my father. He had fallen off a ladder and cut his scalp (76 stitches). When EMS arrived, she had them retrieve the EMI Kit off the refrigerator. (She refused to let go of the towel she was holding to my father’s head. As soon as they saw his medication list, they changed the way they were going to treat him on the spot as he is on a blood thinner. Once she was at the hospital, she handed the form to the clerk. This made everything easier for her. We feel that having this information made a difference in my father’s treatment. We can’t thank you enough.” Sue H., Plaistow, NH
The Emergency Medical Info Kit has a custom designed double pocketed reclosable vinyl envelope with a front pocket which holds a Medical Summary Form and DNR (Do Not Resusitate) form and the main pocket holds the support documents.
Vinyl envelope (to hang on the refrigerator)
Emergency Medical Summary Form
Additional Medication List
Generic Health Care Proxy form
Generic HIPPA Release form
The Medical Summary form goes in the front pocket of your EMI Kit,
making it easy for someone to pull out.
This form will not get mixed up with the support documents
that go in the reclosable back pocket.
A recent photo
Both sides of all insurance cards
Your Advance Directive (living will)
Recent EKG and/or lab results
Organ donor card
$ 9.95 for small 8″ x 10″ vinyl envelope
$ 13.95 for larger 10″ x 12″ vinyl envelope
Disclaimer: All paper, chart and/or electronic formats and information are provided for the sole convenience of the user. HD Merrimack makes no warranties or representations about the product or the supplied forms. There may be state specific and physician signed forms the user needs to obtain, not included in the information provided. The forms provided are guidelines only. The user assumes all responsibility for use of this product, including all information the user puts on the forms and the accuracy of said information as well as any documents inserted/not inserted in this product.