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Emergency Medical Information Form

Keep this form with you at all times if you have a chronic condition so that EMS or emergency room personnel can have quick access to your medical history, medications you are taking and other important information. 

To complete the form, click on the link above, fill in the gray fields, then save it to your computer or a disk and print as many copies as you need.

Make sure that you update the form regularly! Your information will remain strictly confidential - MMC will not be able to view it or save it.

Now available as a wallet card! 

Download and print the Emergency Medical Information Wallet Card.
Print the two-sided card no letter-sized paper, cut out, fill in your information and fold along the dotted lines OR call (207) 662-2196 and request that one be mailed to you.

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Maine Medical Center | 22 Bramhall Street | Portland, Maine 04102-3175 | (207) 662-0111