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- Risk Communicator
- Issue 3
- Emergency & Risk Communication
- Anthrax Scare
- Pan Flu Preparedness
- YouTube is Your Friend
- Additional Resources
- Contributors
- Issue 2
- Priceless Collaboration for Hurricane Preparedness
- Talking to WHO's John Rainford - New WHO Guidelines
- Emergency Communication Challenges in Hurricane Katrina Response
- Hurricane Readiness in High-Risk Areas: Survey Results
- Elements of a Successful Exercise: Functional vs Tabletop and Beyond
- Collaboration & Communication During Emergency Response
- Public Health Observances
- Calendar of Training Opportunities
- Contributors
- Issue 1
- Introduction to the Risk Communicator
- Social Media & Emergency Communication
- Messaging Is Matter of Trust
- Program Spotlight: Frontlines of the CA Wildfires
- Research Summaries: Summaries of Work from Deborah Glik and Craig Lefebvre
- Risk Communication Opportunities During National Observances
- Upcoming Conferences, Training, and Workshops of Interest to Risk Communicators
- Contributors
- About the Newsletter
- Communicating in the First Hours
- SNAPS
- Social Media
- What CDC Is Doing
- What You Can Do
- Blog: Public Health Matters
- What's New
- A - Z Index
HURRICANE RECOVERY INFORMATION
Keep It With You: Personal Medical Information Form
In an emergency situation, people may not be able to get to their medical records. The “Keep It With You” (KIWY) Personal Medical Information Form is intended to be a voluntary and temporary record that lists medical care and other health information for people who need care during disasters and similar situations. It is important for health care workers to have a simple and reliable way to learn information about past and new health concerns for people receiving help.
Directions
Please print out Side 1 & 2 of the KIWY Personal Medical Information Form. The KIWY form should be copied so that it is on 2 sides of one piece of paper.
Please fill out as much as you can on the form. It is okay if you don’t fill out every space. You might want to use a pencil if some information will change, such as your address. Some of the information will be filled out by a health care worker, like “Active Diagnoses” and “Healthcare Encounters” information. If you have an immunization card listing the shots you have recently had, please staple it to the KIWY form.
The KIWY form can be folded and placed in a plastic bag for safe keeping.
For Health Care Workers
The KIWY form is not intended to replace hardcopy or electronic medical records, but is an interim communication tool to assist individuals as they navigate a potentially complex system of temporary support, housing, and clinical services. Clinicians are encouraged to adapt format and content as necessary to best serve the specific situation, population, and clinical care needs. The form provided is intended to serve as a basic tool, providing a framework for more specific refinement.
It is suggested that care providers photocopy the document after an individual receives care, in order to maintain a record of who was seen and what treatment was provided. The original form is intended to remain with the individual during the time they are displaced. The form can serve as an interim summary when normal care can be resumed.
Download the Form
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- Page last reviewed June 9, 2006
- Page last updated September 13, 2005
- Content source: National Center for Environmental Health (NCEH)/Agency for Toxic Substances and Disease Registry (ATSDR), National Center for Injury and Violence Prevention and Control (NCIPC)
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