Working in the emergency room, I frequently see children brought in by caregivers other than their parents (grandparents, aunts, babysitters, coaches, teachers, and neighbors – to name a few). Parents are often “on the way” or available by phone, but it can be difficult to get the child’s full medical history in a timely fashion. While most children are relatively healthy at baseline, there can be key pieces of information regarding their history that may change what we do for them in an emergency setting.
Keeping a current “Medical History” form can be extremely helpful at these times. For younger children who are being watched at home, put a form like this on the fridge or kitchen bulletin board. In older children and adolescents, a copy can be placed in their backpacks, purses, or wallets. There are also multiple medical history apps available for older children who carry their cell phones with them wherever they go.
Here is an example of what information should be included:
Full name, and what the child prefers to be called
(Example: Samuel Smith, called “Sammy”)
Date of birth
Medical History: Include any medical diagnoses that your child carries. Also include any past overnight hospitalizations.
Example: asthma, seasonal allergies, eczema
hospitalized for 3 days in November 2013 due to asthma flare
Surgical History: Include any surgical procedures your child has had and when.
Example: ear tubes, June 2013
Medications: Include any current medications, dosages, and when they are taken. Include any “as needed” medications that your child needs frequently.
Example: Singulair 5 mg once a day in the evenings
Albuterol inhaler 2 puffs as needed only (usually about twice a week)
Allergies: Include any allergies to medications and what the allergic reaction was. You may also include any food allergies or restrictions.
Example: Amoxicillin – rash
Peanuts – hives and trouble breathing
Immunizations: Include most recent immunizations when possible. Make sure you note if you have refused any immunizations.
Example: Up-to-date through 2-year-old visit
Parents’ (or primary caregiver’s) names and contact information: You may also want to include another emergency contact here (like a grandparent or close friend).
Example: Mary Smith, Mom. Cell: XXX-XXX-XXXX, Work: XXX-XXX-XXXX
Joe Smith, Dad. Cell: XXX-XXX-XXXX, Work: XXX-XXX-XXXX
Amy Brown, Grandmother. Cell: XXX-XXX-XXXX
Medical caregivers’ names and contact information: Include your child’s primary care doctor and any specialist that he may see.
Example: Dr. Kevin Jones, Pediatrician. Office number: XXX-XXX-XXXX
Dr. Jill Rogers, Asthma specialist. Office number: XXX-XXX-XXXX
Depending on your comfort level, you may also wish to attach a current photo and a copy of your child’s medical insurance card.
You can either plan to make the form yourself and add it to the to-do list, or download and complete this pre-populated form. Stay safe!