Advanced Search
Select up to three search categories and corresponding keywords using the fields to the right. Refer to the Help section for more detailed instructions.

Search our Collections & Repository

All these words:

For very narrow results

This exact word or phrase:

When looking for a specific result

Any of these words:

Best used for discovery & interchangable words

None of these words:

Recommended to be used in conjunction with other fields

Language:

Dates

Publication Date Range:

to

Document Data

Title:

Document Type:

Library

Collection:

Series:

People

Author:

Help
Clear All

Query Builder

Query box

Help
Clear All

For additional assistance using the Custom Query please check out our Help Page

i

Keep It With You personal medical information form

Filetype[PDF-70.59 KB]


  • English
    • Details You May Also Like

    Details:

    • Alternative Title:
      KIWY
    • Corporate Authors:
      Centers for Disease Control and Prevention (U.S.)
    • Description:
      In an emergency situation, people may not be able to get to their medical records. The “Keep It With You” (KIWY) Personal Medical Information Form is intended to be a voluntary and temporary record that lists medical care and other health information for people who need care during disasters and similar situations. It is important for health care workers to have a simple and reliable way to learn information about past and new health concerns for people receiving help.

      Directions:

      Please print out Side 1 & 2 of the KIWY Personal Medical Information Form. The KIWY form should be copied so that it is on 2 sides of one piece of paper.

      Please fill out as much as you can on the form. It is okay if you don’t fill out every space. You might want to use a pencil if some information will change, such as your address. Some of the information will be filled out by a health care worker, like “Active Diagnoses” and “Healthcare Encounters” information. If you have an immunization card listing the shots you have recently had, please staple it to the KIWY form.

      The KIWY form can be folded and placed in a plastic bag for safe keeping.

      Last reviewed June 9, 2006 Last Modified 9/12/2005 11:49 AM

      kiwy.pdf

    • Subjects:
    • Document Type:
      Pamphlet (or booklet)
    • Genre:
      Forms
    • Collection(s):
    • Main Document Checksum:
    • Download URL:
    • File Type:

    Supporting Files

    • No Additional Files

    More +

    You May Also Like

    Checkout today's featured content at stacks.cdc.gov