The Emergency Information Form (EIF) for Children With Special Health Care Needs is available as an interactive PDF file to complete online or print and complete by hand.

Emergency Information Form (pdf)

This form was created by the American College of Emergency Physicians and the American Academy of Pediatrics.

This important document will assure prompt and appropriate care for Children with Special Health Care Needs (CSHCN). Now, when these patients present to emergency departments or health care professionals with an acute illness or injury, physicians, parents, EMS professionals, and nurses will be able to use the EIF as a tool to transfer critical information.

The EIF will ensure that a child's complicated medical history is concisely summarized and available when it is needed most - when the child presents with an acute health problem at a time when neither parent nor pediatrician is immediately available.

Why Emergency Preparedness is Important

Emergency physicians and pediatricians provide medical care to many children with special needs because of chronic, complex medical illnesses. Their care may be complicated by the lack of patient history information, and unusual and uncommon disease processes.

To optimize emergency care of children with special needs, records of each child's special needs should be maintained in an accessible and usable format. The exact form in which relevant information is stored may vary depending on individual physician and patient preference. We recommend that you consider using the Care Notebook we have developed.

Family Emergency Information Planning Kit

In our fast-paced lives, there never seems to be time to really plan ahead for emergencies, so we have prepared “Family Emergency Information Planning Kits” to help your family get prepared for any type of emergency, including tornadoes, hurricanes, floods, etc. Using our kit and a small amount of your time invested now, could end up saving you and your family a lot of frustration later. If some sort of natural disaster requires that you leave your home quickly, taking the time now to gather, record and save vital information, all in an easily accessible place, will make the experience much less traumatic when you just grab your kit and go.

Visit Request Information and complete the form with "Requesting a Family Emergency Information Planning Kit”, and we will mail you a planning kit for your family.

Emergency Information Magnet

We suggest that you always have your family's emergency information available. We have designed a form that may be useful to you. Click here to print the emergency info form (la segunda cara en español) to insert into your own magnetic 4"x6" photo frame or visit Request Information and complete the "other request" box of the online form with "Requesting an Emergency Information Magnet”, and we will mail you a magnet for your family.

FREE Medical Emergency Information Wallet Card

Go to this website for a free wallet card creator that produces a completed (ICE -in case of emergency) 911 information medical card, list of Rx meds, emergency phone number form for personal contacts, physician and preferred hospital, and other personal medical information etc., in just minutes that would prove invaluable in providing treatment when you are unable to speak for yourself and should always be kept in your wallet. Click to get started on creating free card.

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DISCLAIMER: Within this web site, there are links to "outside sites" which are not managed by the Family Voices of Alabama (FV of AL).  FV of AL does not endorse nor recommend the information or products posted on these sites, and receives no payment or other consideration for providing these links.

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