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DISASTER PREPAREDNESS
SPECIAL NEEDS AND DISABILITIES
- Carry a health information card if you
have special needs.
- Evaluate your capacities, limitations,
needs, and surroundings
- Determine type of help you may need
during an emergency.
- List information: doctors, allergies,
medications, disabilities, equipment
- Keep sufficient medication and supplies
for at least 7 days on hand.
Use the following
worksheets, print this page out and put your own personal information in the
following tables:
| Use this
space to describe your special needs:
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HEALTH CARE PROVIDERS
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NAME
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SPECIAL
NEEDS |
PROVIDER |
PHONE |
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MEDICATION LIST
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NAME
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MEDICATION & DOSAGE
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PHYSICIAN & PRESC. #
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REASON FOR TAKING MED.
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Be cautious of writing names of narcotics and
other drugs that could be stolen.
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