MAKE A PLAN - Dallas · 2019. 12. 3. · MAKE A PLAN Communication is a major part of emergency...
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MAKE A PLAN Communication is a major part of emergency preparedness. Talk together as a family so everyone knows the following: How will you stay in touch with your family? Where will you meet if you’re separated? Family Emergency Contact and Medical Information _____________________________________________________ OUT OF TOWN Contact Name ___________________ ___________________ ___________________ Home Phone Cell Phone Work Phone ___________________________________________ Address ___________________________________________ City, Street, ZIP Code Alternative Emergency Contacts _______________________________ _______________________________ Local Emergency Contact ___________________ ___________________ ___________________ Home Phone Cell Phone Work Phone _______________________________ _______________________________ Address Address _______________________________ _______________________________ City, Street, ZIP Code City, Street, ZIP Code Medical Information _____________________________________________________ Hospital / Clinic Preference ______________________________________ ___________________ Physician’s Name Phone Number ______________________________________ ________________________ Insurance Company Policy Number ________________________________________________________________ Allergies / Special Health Considerations Family Contact and Medical Information _______________________________ ___________________ Family Member’s Whole Name Date of Birth _______________________________ _______________________________ Email Alternate Email ___________________ ___________________ Home Phone Work Phone _______________________________ _______________________________ Address Address _______________________________ _______________________________ City, Street, ZIP Code City, Street, ZIP Code ________________________________________________________________ Allergies / Special Health Considerations Family Contact and Medical Information _______________________________ ___________________ Family Member’s Whole Name Date of Birth _______________________________ _______________________________ Email Alternate Email ___________________ ___________________ Home Phone Work Phone _______________________________ _______________________________ Address Address _______________________________ _______________________________ City, Street, ZIP Code City, Street, ZIP Code ________________________________________________________________ Allergies / Special Health Considerations FAMILY COMMUNICATION PLAN
Transcript of MAKE A PLAN - Dallas · 2019. 12. 3. · MAKE A PLAN Communication is a major part of emergency...
MAKE A PLAN
Communication is a major part of emergency preparedness.Talk together as a family so everyone knows the following:
How will you stay in touch with your family?Where will you meet if you’re separated?
Family Emergency Contact and Medical Information
_____________________________________________________OUT OF TOWN Contact Name___________________ ___________________ ___________________Home Phone Cell Phone Work Phone___________________________________________Address___________________________________________City, Street, ZIP Code
Alternative Emergency Contacts
_______________________________ _______________________________Local Emergency Contact___________________ ___________________ ___________________Home Phone Cell Phone Work Phone_______________________________ _______________________________Address Address_______________________________ _______________________________City, Street, ZIP Code City, Street, ZIP Code
Medical Information
_____________________________________________________Hospital / Clinic Preference______________________________________ ___________________Physician’s Name Phone Number______________________________________ ________________________Insurance Company Policy Number________________________________________________________________Allergies / Special Health Considerations
Family Contact and Medical Information
_______________________________ ___________________Family Member’s Whole Name Date of Birth_______________________________ _______________________________Email Alternate Email ___________________ ___________________Home Phone Work Phone_______________________________ _______________________________Address Address_______________________________ _______________________________City, Street, ZIP Code City, Street, ZIP Code________________________________________________________________Allergies / Special Health Considerations
Family Contact and Medical Information
_______________________________ ___________________Family Member’s Whole Name Date of Birth_______________________________ _______________________________Email Alternate Email ___________________ ___________________Home Phone Work Phone_______________________________ _______________________________Address Address_______________________________ _______________________________City, Street, ZIP Code City, Street, ZIP Code________________________________________________________________Allergies / Special Health Considerations
FAMILY COMMUNICATION PLAN
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