Emergency transport system
(if the 9-1-1 system is not available in your area):

Post the poison center telephone number by every telephone in your home. To locate the nearest poison center call: (202) 362-7217 or write to:

American Association of Poison Control Centers
3201 New Mexico Avenue, NW, Suite 310
Washington, DC 20016

Poison control:

Physician's name/telephone:

Hospital emergency room:

Police:

Fire:

Other:

This information is about:

Child's full name:

Date of birth:

Height: at last physical in:

Weight: at last physical in:

Home address:
    
    

Directions to home:

Home telephone:

Allergies:

Medical conditions:

Current medications:

Child's physician:

Child's dentist:

Medical insurance company:

Policy holder's name:

Policy number: Group number:

Immunizations and dates:

Emergency contacts:

Contact person #1:

Name:

Relationship:

Work or home address:
    
    

Telephone:
    Home:
    Work:

Contact person #2:

Name:

Relationship:

Work or home address:
    
    

Telephone:
    Home:
    Work:

Contact person #3:

Name:

Relationship:

Work or home address:
    
    

Telephone:
    Home:
    Work: