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Vital Records Program


The information you provide will increase the likelihood of receiving timely and appropriate intervention when police, fire and emergency personnel are called to your home in case of a medical emergency. In addition to basic medical information and emergency contact numbers, this form contains suggestions on how to best facilitate communication when there are hearing, vision, speech or memory difficulties that make it difficult to provide all the needed information.

In an emergency situation, every minute counts and access to updated medical information can save not only time but lives.
  1. Complete the form for yourself and have every member of you household complete one. It is important to have a contact person who is nearby in case you are taken to the hospital and you have a loved one who cannot be left alone or pets you are responsible for.
  2. If someone is having difficulty filling in the information, please assist them. In the case of visual limitations, you may need to make a copy that has larger print. Complete the information in pencil so that it can be updated more easily.
  3. Complete as much of the information as possible. If a question does not apply, please write N/A (not applicable).
  4. Since medication lists are not always updated, we strongly urge you to keep you CURRENT medications in one place so emergency personnel can access them easily. The actual pill bottles will contain essential information. Information about non-prescription medications or vitamins and supplements you are taking will be equally as important. NOTE: If you update your medications EVERY time they are changed, you may want to keep a card inside your packet with that information. ALWAYS include the date when your list was last updated.
  5. Important medical history should be included. If there is additional information you feel is important and not covered on the form, place it in the packet with your VITAL RECORDS.
  6. The second page has information about communication and is primarily a checklist. If you want to include additional information that might be helpful, use the lines provided at the end of the appropriate section.
  7. You may want to make an extra copy of your completed form. Emergency responders may choose to take this information with them when transporting you to the hospital. You may want to keep an extra copy in the glove compartment of your car. If you decide to take a copy to your doctor's appointment, make sure you update it if necessary and return it to the packet containing you VITAL RECORDS.
  8. Place the VITAL RECORDS information inside the vinyl packet. Peal the plastic off of the fastening tape and stick the bag to the clean inside right wall of the refrigerator below the level of the first shelf. The VITAL RECORDS magnet has been provided to inform first responders that you are a participant and that they can find your packet inside the refrigerator. Place the magnet free of other clutter on the upper right corner of the outside of your refrigerator door to increase visibility. Emergency crews will be trained to look for the VITAL RECORDS magnet. It would be helpful if you could make them aware of your participation upon their arrival at your residence.
  9. REMEMBER it is very important to update your VITAL RECORDS periodically - especially when a change occurs. Misinformation can delay your ability to get the appropriate intervention in a timely manner. If there are no changes, review your VITAL RECORDS at least twice a year to make sure the information is current. A good time to do this is when you reset the clocks and check your smoke detector batteries twice a year.

Please spread the word. Tell you neighbors and ensure that they are protected as well with the SEVEN HILLS VITAL RECORDS PROGRAM.

For additional forms and information contact Tony Terry in Seven Hills City Hall at (216) 525-6230 or to download additional forms online.

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