Magnetic $4.95 USD, Velcro Type $4.95USD
Single pocket vinyl envelope with a front pocket which holds the Emergency Medical Summary Form, Medication List and a physician signed DNR or POLST form.
Emergency Medical Summary Form
Additional Medication List
Generic Health Care Proxy form
1 Vinyl 6” x 7” vinyl envelope
Choices of magnetic, Velcro or plain
with magnet or Velcro style hook and loop
to hang on the refrigerator or cabinet
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.