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Miss Pebbles Flintstone 04/07/2000 09/24/1994 Flintstone HP:(703) 555-1212 WP:(555) 888-6767 tel:(999)555-2647 Neighbor Mrs. Betty Rubble III Mrs. Wilma Flintstone en-US 123 Main Street Kalamazoo, AK 28900 Dr. Rocky Slagstone (703) 555-2626 Height Weight Blood Pressure 177 cm 86 kg 132/86 mmHg Total hip replacement, left 1998

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Page 1: EmergencyInfoForm_Printed

Miss Pebbles Flintstone

04/07/2000

09/24/1994

Flintstone

HP:(703) 555-1212 WP:(555) 888-6767

tel:(999)555-2647

NeighborMrs. Betty Rubble III

Mrs. Wilma Flintstone

en-US

123 Main Street Kalamazoo, AK 28900

Dr. Rocky Slagstone (703) 555-2626

Height

Weight

Blood Pressure

177 cm

86 kg

132/86 mmHg

Total hip replacement, left

1998

Page 2: EmergencyInfoForm_Printed

Albuterol inhalant - 2 puffs QID PRN wheezing

Clopidogrel (Plavix) - 75mg PO daily

Metoprolol - 25mg PO BID

Prednisone - 20mg PO daily

Cephalexin (Keflex) - 500mg PO QID x 7 days (for bronchitis)

Flintstone

Penicillin

Aspirin

Codeine

Hives

Wheezing

Nausea

Automatic implantable cardioverter/defibrillator

Total hip replacement prosthesis

Asthma

Pneumonia

Pneumonia

1950

Jan 1997

Mar 1999

Active

Resolved

Resolved

Tetanus and diphtheria toxoids, IM 1997Influenza virus vaccine, IM Dec 1998Pneumococcal polysaccharide vaccine, IM Dec 1998Tetanus and diphtheria toxoids, IM 1998Influenza virus vaccine, IM Nov 1999

Influenza virus vaccine, IM 2000Influenza virus vaccine, IM Oct 2001Influenza virus vaccine, IM Sep 2002