Emergency Care Plan Template Page 2

Health Information

Details about the person I care for

Person’s illness or disability

Doctor

Name

Address

Telephone

Medicare number

Health Insurance Fund

Name of Fund

Telephone

Membership number

Ambulance Fund/Registration number

Medic-Alert number

Description of care needs

Care Required

The person I am caring for needs

Meals only

Regular visits only

Full-time care – mobile, no personal care required

Full-time care – mobile, supervision of toileting and showering required

Full-time care – mobile, assistance with toileting, showering/bathing required

Full-time care – assistance with lifting/transferring, toileting and

showering/bathing required

Other

Supervision

Toileting

When

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Parent category: Medical