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ER Form for Bleeding Disorders

Form helps parents share critical info during ER visits

By Melanie Padgett Powers | 06.27.2011
Originally Published June 2011
Emergency room sign

An Emergency Information Form for Children with Special Health Needs is available to help parents explain their child’s complicated medical history when they must visit the emergency room. The form was created by the American College of Emergency Physicians and the American Academy of Pediatrics. The two organizations say that physicians, parents, EMS professionals and nurses will be able to use the form as a tool to transfer critical information.

The child’s physician or hemophilia treatment center staff fill out the medical information ahead of time, so the parent can hand ER staff the form when needed. Parents are also encouraged to give copies of the form to all of their child’s caregivers.

For children registered with the MedicAlert® Foundation, the organization can keep the form on file so healthcare professionals can access it 24 hours a day.

Download the Emergency Information Form for Children with Special Health Needs.

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