Medical Card Generator - Lotsofkids.com

Medical Summary Card During pregnancy, it's often a good idea to carry your basic medical information. Use this form to generate a simple medical summary card that you can print and keep with you in case you need medical aid or are meeting with someone who has not cared for you before. This is particularly handy if you've had numerous pregnancies and don't want to verbally give all the dates and information. You may want to give a copy of this to your husband or trusted family member, so they can provide it to your caregiver should you be unable to. Please Note: We offer this utility as a service to our members. A one-time card will be generated; if you need to make changes, you will have to hit the BACK button on your browser and re-enter the information. This is for your protection and privacy. NO information will be saved on our system.

About You:
First Name:
Last Name:
Address 1:
Address 2:
Phone #
Alternate Phone #:
Due Date:	/ /
Birthday:	/ /
Blood Type:
Medications:
Allergies:

About Your Insurance:
Provider:
Provider Phone:
Plan:
Policy #:

Emergency Contact Information:
Name:
Relationship to you:
Phone #:
Alternate Phone #:

Your Risks: Select all that apply:
Common risks:	(Hold down CTLR to select multiple risks.)
Other Risks:

Medical History: Enter dates and pertinent information for the following:
Previous Surgeries (Non-Pregnancy Related):

Hospital Stays this Pregnancy:

Other Medical:

Pregnancy History: Enter dates and/or pertinent information for the following:
# of pregnancies:
# of living children:
Full-term births:
Pre-term births:
Miscarriages:
Vaginal Births:
C-Sections:
Other Pregnancy Conditions/Complications:

Disclaimer: The information provided in this section is for the entertainment of our visitors and is only for educational purposes. It is not intended to take the place of the advice and/or care of a qualified healthcare professional. Remember that every woman and every pregnancy is unique, and Lotsofkids.com provides only general information about conception, pregnancy and birth. The information contained in this site should not be used as a substitute for care you should receive from a qualified healthcare professional. If you have questions or concerns about your health or the health of your baby, please seek the advice of your healthcare provider.