Save Your Life

Below is a medical form for the lake residents to voluntarily fill out. On this form we are asking you to put your name, age, address and a family member or friend that the patrol could call in case of an emergency. At the bottom of the form list any type of medical problem(s) you might have: heart disease, diabetes, seizures, etc., also list any type of allergic reactions you might have to medications.

After we have collected all of the medical forms I will put them in alphabetical order in a folder, the patrol deputies will carry a copy of this folder in the patrol cars and a copy will go to the paramedics. When the paramedics are responding to your house they will already know what type of medication you are taking and allergies you may have. Lake Patrol being your first responder to any medical call this information will alert and assist deputy and E.M.S. to any prior history situations.

Thank you, Chief Dan Summers.
MEDICAL INFORMATION FORM
PERSONAL INFORMATION:
Name: Date:
Phone No.:
Address:
   
Date of Birth: Family Doctor:    
Doctor Phone:
 
EMERGENCY CONTACT INFORMATION:
Person to contact in the case of an emergency:
 
Their Phone:
 
Their Address:
 
 
MEDICAL INFORMATION
List all of your medical problems and medication:
Illness: Medication:
Illness: Medication:
Illness: Medication:
Illness: Medication:
 
List any other information that would help the patrol or paramedics. (Example: Wheel Chair Bound on Oxygen)