Personal Health Record at a glance
What it is: The PERSONAL HEALTH RECORD of (name) has the Name, Age, Address, Phone#, E-Mail and EMERGENCY CONTACT.
A filled-in Personal Health Record example: a woman fills out her own record

How to fill out Personal Health Record, box by box
Your record and emergency contact
Emergency contact relationship
Health care proxy 1 and 2
Doctors
Allergies
Health problems

For HEALTH PROBLEMS:, mark NONE, or mark each one that applies from Arthritis, Asthma, Bleeding Problem, Breathing Difficulty, COPD, Cancer (where), Depression, Diabetes (sugar in the blood), Heart Problems, Hearing Problems, High Blood Pressure, High Cholesterol, Osteoporosis, Seizures, Thyroid Problem and Other.
Medications
Screening tests and vaccines
Sources
[1] Personal Health Record (generic template, no issuer file) (the Official source link on this page).









