Gympie Get Ready Resilience Toolkit

Personal Health & Medical Information Record

IMPORTANT NOTE: Your confidential records contain personal information that identifies you. Keep all information and documentation in a secure place. Do not use the USB which contains this information for any other use. If lost or used for any other purpose, your identity could be stolen.

Getting Yourself Prepared

Personal Health & Medical Information Record

Important Note: Keep a copy of this with your-Get Ready Plan Documents

Name Blood Type Alerts and Allergies

Medications List
Drug Name (brand/ generic) What it is for When it is taken How much is taken Side Effects/ Issues

Medical History Do you suffer from/of the following?

Heart Disorder Asthma Migraines Fainting Spells High Blood Pressure Epilepsy Thyroid Problems Dizziness Wear Glasses/Contacts Have a Hearing Aid Use Mobility Aids Use Other Aid Y Y Y Y Y Y Y Y Y Y Y Y N N N N N N N N N N N N

Gympie Regional Council June 2012

Gympie Get Ready Personal and Household Resilience Toolkit | page 18

Getting Yourself Prepared

Personal Health & Medical Information Record

Well Woman Check List

Test
Weight (BMI) Cholesterol Total HDL (good) LDL (bad) Blood Pressure Mammogram Pap Smear Colorectal Cancer Diabetes STIs HIV Infection Bone Density Depression Eye Sight Skin Check Immunisations Hearing Screen Lifestyle Issues
Always have your essential (or lifesaving) medications with you at all times. This applies to those in your care as wellchildren, elderly, a person requiring support or your pet/s. Remember to always try to keep at least two weeks medications on hand. Do not allow yourself to run out or have less than two weeks supply on hand. In emergencies, medical supplies and replacement scripts are harder to access.

Last Test
(month/year)

Results

Next Test Due

(month/year)

Questions
for the Doctor

Gympie Regional Council June 2012

Gympie Get Ready Personal and Household Resilience Toolkit | page 19

Getting Yourself Prepared

Personal Health & Medical Information Record

Well Man Check List

Test
Weight (BMI) Cholesterol Total HDL (good) LDL (bad) Blood Pressure Testicular Cancer Prostate Cancer Colorectal Cancer Diabetes STIs HIV Infection Bone Density Depression Eye Sight Skin Check Immunisations Hearing Screen Lifestyle Issues
Always have your essential (or lifesaving) medications with you at all times. This applies to those in your care as wellchildren, elderly, a person requiring support or your pet/s. Remember to always try to keep at least two weeks medications on hand. Do not allow yourself to run out or have less than two weeks supply on hand. In emergencies, medical supplies and replacement scripts are harder to access.

Last Test
(month/year)

Results

Next Test Due

(month/year)

Questions
for the Doctor

Gympie Regional Council June 2012

Gympie Get Ready Personal and Household Resilience Toolkit | page 20