Caregiver Medical Sheet

Caregiver Medical Information Sheet | The Senior Living Report
Print this sheet and bring it to every appointment and emergency.
Free Resource · 2026 Edition
The Senior Living Report

Caregiver Medical Information Sheet

A one-page record of diagnoses, medications, doctors, insurance, and emergency contacts
Steve Wilson, BSN RN · Registered Nurse & Patient Advocate

Why This Sheet Matters

In an emergency, the people responding to help your loved one need information fast. What medications are they on? Who is their cardiologist? What is their insurance number? What allergies do they have? If that information is not immediately available, care can be delayed — and in some situations, that delay matters enormously.

I have seen this play out in emergency rooms. A family member arrives with their loved one but cannot remember the names of their medications, does not have the insurance card, and has no idea who the specialist is. It creates chaos at exactly the wrong moment.

Fill this out completely. Print it. Keep one copy with your loved one, one in your wallet or phone case, and one posted somewhere visible at home — the refrigerator is the first place emergency responders look.

“This is the single most practical thing a caregiver can do today. You hope you never need it in an emergency. But if you do, you will be grateful it exists.”

Medical Profile

Complete & Keep Current

01
Patient Information
Full Legal Name
Date of Birth
Address
Phone Number
Blood Type
Primary Language
02
Emergency Contacts
List at least two contacts. Include the person who holds healthcare power of attorney.
Contact 1 — Name
Relationship
Phone (Primary)
Phone (Secondary)
Contact 2 — Name
Relationship
Phone (Primary)
Healthcare POA Name & Phone
03
Insurance Information
Medicare Number
Medicare Plan Type
Supplemental Insurance
Policy Number
Medicaid Number (if applicable)
Insurance Customer Service #
04
Diagnoses & Allergies
List all active diagnoses. For allergies, include the reaction type — not just the allergen.
Primary Diagnosis
Secondary Diagnosis
Additional Diagnoses
Allergies (medication, food, environmental) — include reaction type
05
Current Medications
Include all prescription medications, over-the-counter medications, vitamins, and supplements. Update this list every time a medication changes.
Medication Name Dose Frequency Prescribing Doctor Reason
06
Physicians & Specialists
Include the primary care physician and all specialists. Add the pharmacy as well.
Name Specialty Phone Address / Practice
Pharmacy
07
Advance Directives & Legal Documents
Note the location of each document. Emergency responders and hospital staff need to know these exist and where to find them.
Living Will / Advance Directive — Location
Healthcare POA — Location
POLST / DNR — Location
Durable POA (Financial) — Location
Special Instructions for Emergency Responders

Keep This Sheet Current

Review and update this sheet every time a medication changes, a new diagnosis is made, or a doctor changes. Date your updates so you always know how current the information is.

Keep one copy at home in a visible location. Give a copy to your primary caregiver. Consider keeping a photo of it on your phone. And bring it to every medical appointment — it will save you time and may save your life.

The Senior Living Report
theseniorlivingreport.com/caregiver-medical-sheet
Steve Wilson, BSN RN · Registered Nurse & Patient Advocate
© 2026 The Senior Living Report. For informational purposes only.

Picture of Steve Wilson, BSN RN

Steve Wilson, BSN RN

I spent more than 20 years as a registered nurse before stepping back from the bedside — but I never stepped back from the work. Patient advocacy is still very much part of my weekly life, sitting with patients and families at some of the most important and difficult moments of their lives. I am a registered nurse with a Bachelor of Science in Nursing, certified in Alzheimer's and dementia care through the Alzheimer's Association's EssentiALZ program. I built The Senior Living Report to give you the same plain-language, nurse-informed guidance I would give a member of my own family — without overwhelm, confusion, or fear.

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