| Emergency Information |
| To be posted on home refrigerator and a copy given to a trusted neighbor with a copy of your house key. |
| First Person to be Contacted (to take charge of situation and make critical decisions in my spouse's absence): Name:_____________________________________ Relationship:_____________ Home Phone:_______________________________ Work Phone:_______________ My Medical Record is located:________________________________________ My Will is located:__________________________________________________ My Advanced Directive is located:____________________________________ My Living Will is located:___________________________________________ Send an American Red Cross Message (from the hospital where I am/died) to: My Spouse's Name:______________________________________ Rank:________ Work Phone:__________________ Social Security #:_____________________ Unit Address:________________________________________________________ Person Authorized to care for my children until guardian or spouse arrives: Name:________________________________________________________________ Address:_____________________________________________________________ Home Phone:______________________________ Work Phone:________________ Alternate Person authorized to care for my children until guardian or spouse arrives: Name:________________________________________________________________ Address:_____________________________________________________________ Home Phone:______________________________ Work Phone:________________ Child's Name:_______________________ Child's Name:___________________ Age:_____ Social Sec#:______________ Age:_____ Social Sec#:__________ Phone/School:_______________________ Phone/School:___________________ Home Phone:_________________________ Home Phone:_____________________ Address:____________________________ Address:________________________ Child's Name:_______________________ Child's Name:___________________ Age:_____ Social Sec#:______________ Age:_____ Social Sec#___________ Phone/School:_______________________ Phone/School:___________________ Home Phone:_________________________ Home Phone:_____________________ Address:____________________________ Address:________________________ (Additional Children on back of page.) |
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