A patient or caregiver can use this form to keep track of hospital admissions, transport via ambulance and other means, and other emergency actions. It is useful for medical incidents, mental health actions, and other purposes. There is also space on which to note symptoms and treatment (or denial of treatment), which can be useful when consulting with insurance or a primary care provider.
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This Medical Form is available in two versions: a free, ready-to-use version and a $3.99 editable version.
The free version is available in PDF format: just download one, open it in a can display the PDF file format, and print.
The $3.99 version can be edited. It is compatible with Microsoft Word.
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