You know things about this person that no chart contains. In an emergency room nobody has time to ask you, and sometimes nobody thinks to. This puts what you know on one page, so it gets read even when you are not being heard.
Fill in what you know. Skip anything that does not apply. A half finished profile is still better than nothing on the worst night of the year.
Nothing you type here is sent anywhere. It stays in your browser.
This is the part hospitals do not have and cannot guess. The word "confused" means nothing to a stranger without knowing what this person is like when they are well.
Hospitals lose these constantly, and a person without their hearing aids looks confused to a stranger.
Two or three sentences, in your words. This is the single most useful thing on the page.
One per line, with the dose if you know it. If you have a printed list from the pharmacy, bring that too and just write "see attached list" here.
Include reactions that are not true allergies but matter anyway, like a medication that makes them delirious.
Naming someone here does not by itself give them legal authority. The document does that. This page tells the team who to look for and where the paperwork is.
Check only what actually exists on paper. Bring the originals or copies with you.
On purpose, this tool never asks for a member ID, a Social Security number, or an account number. Bring the card. A page that lives on a refrigerator should not carry numbers someone could misuse.
This prints in a box at the top of the profile, under your name. It is the part that says a person who knows this patient is standing right here. Write it the way you would say it.
I am Rachel Nash, a Board Certified Patient Advocate. A large part of my work is making sure the person who knows the patient best is actually in the conversation. If that is not happening, reach out. A first conversation costs you nothing.
Nash Patient Advocacy & Consulting, LLC · Rock Hill, SC · serving North and South Carolina
rachel@nashadvocacy.com
Please read before you begin
This tool gives general education about how to write down a person's health information for an emergency. It is not legal advice, not medical advice, and not financial advice, and it is not a guarantee of any outcome.
Rules change and every situation is different. Using this tool does not make Nash Patient Advocacy & Consulting your representative and does not create an advocate-client relationship.
Your own paperwork governs. The deadlines, phone numbers, and instructions printed on your own notice or letter are the ones that count. Confirm with the number on that paperwork, with the patient's plan, or with 1-800-MEDICARE.
Your privacy. Nothing you type is sent to Nash Patient Advocacy. We never see it and we store nothing. Everything stays in your browser, and any PDF is built on your own device.
This works on a computer, a phone, or a tablet. The one thing we cannot control is who is near you while you fill it in. If there are other people around, turn the screen away or wait until you have a private moment.
Nash Patient Advocacy & Consulting, LLC
Rachel Nash, MRC, BCPA · North and South Carolina