2013Medical-Information-card 1 |
Previous | 1 of 1 | Next |
|
small (250x250 max)
medium (500x500 max)
Large
Extra Large
large ( > 500x500)
Full Resolution
All (PDF)
|
This page
All
|
Important reminders
about your doctor appointments:
1.
Take Your SoonerCare ID Card to your appointment.
2.
Call your doctor for an appointment as soon as possible if you are sick or need a checkup.
3.
Take all your current medicine or a list of the medications you are taking.
4.
Arrive at your appointment 10 minutes early in case you need to fill out paperwork.
5.
Write down your doctor’s instructions.
6.
Prescriptions written by your doctor may be filled at any pharmacy contracted with SoonerCare.
7.
If you must cancel your appointment, please call your doctor as soon as possible so another patient can be scheduled for that time.
8.
Take this card to your doctor appointment if you need help filling out this information.
My Personal Health Information
Name
Phone Number
Blood Type
My Medical Home (Health Care Provider)
Phone Number
Pharmacy
Phone Number
My Health Statistics
Shot Record :
Shot Date Shot Date
Shot Date Shot Date
Shot Date Shot Date
Shot Date Shot Dat
About Me
Birthday__/__/____ Height ____ ft. ___in.
Weight___________ Blood Type _______
Checkup Date __/__/__ Checkup Date _/__/__
Next Appointment __/__/__
√Times Per Day
Emergency Medical Information
Emergency Contacts
1. Name Phone #
2. Name Phone #
My Medical Home
1. Doctors’ Name Phone #
2. Doctors’ Name Phone #
3. Doctors’ Name Phone #
4. Doctors’ Name Phone #
5. Dentist Name Phone #
Medical Conditions and History
Current Medications:
Medication Dose AM Noon PM
Medication Dose AM Noon PM
Medication Dose AM Noon PM
Medication Dose AM Noon PM
Allergies
Medical Conditions
My Medical Home
SoonerCare Helpline
800-987-7767 or 711(TDD)
Update your status at
www.mysoonercare.org
Renewal Date
Keep a copy of this card in your billfold and your child’s backpack or diaper bag.
SCAENG-MEDINFO-2013 www.okhca.org
Object Description
| Okla State Agency |
Health Care Authority, Oklahoma |
| Okla Agency Code |
'807' |
| Title | My medical home |
| Alternative title | 2013 medical information card |
| Authors | Oklahoma Health Care Authority. |
| Publisher | Oklahoma Health Care Authority |
| Publication Date | 2013-03-14 |
| Publication Type |
Other |
| Subject |
Medical records--Oklahoma. SoonerCare (Program) |
| Purpose | pocket card to record medical information for SoonerCare clients |
| Notes | SoonerCare |
| OkDocs Class# | H1300.1 M995m 2013 |
| Digital Format | PDF, Adobe Reader required |
| ODL electronic copy | Downloaded from agency website: www.okhca.org/publications/pdflib/2013Medical-Information-card.pdf |
| Rights and Permissions | This Oklahoma state government publication is provided for educational purposes under U.S. copyright law. Other usage requires permission of copyright holders. |
| Language | English |
| Date created | 2013-04-01 |
| Date modified | 2013-04-01 |
| OCLC number | 890222843 |
Description
| Title | 2013Medical-Information-card 1 |
| Full text | Important reminders about your doctor appointments: 1. Take Your SoonerCare ID Card to your appointment. 2. Call your doctor for an appointment as soon as possible if you are sick or need a checkup. 3. Take all your current medicine or a list of the medications you are taking. 4. Arrive at your appointment 10 minutes early in case you need to fill out paperwork. 5. Write down your doctor’s instructions. 6. Prescriptions written by your doctor may be filled at any pharmacy contracted with SoonerCare. 7. If you must cancel your appointment, please call your doctor as soon as possible so another patient can be scheduled for that time. 8. Take this card to your doctor appointment if you need help filling out this information. My Personal Health Information Name Phone Number Blood Type My Medical Home (Health Care Provider) Phone Number Pharmacy Phone Number My Health Statistics Shot Record : Shot Date Shot Date Shot Date Shot Date Shot Date Shot Date Shot Date Shot Dat About Me Birthday__/__/____ Height ____ ft. ___in. Weight___________ Blood Type _______ Checkup Date __/__/__ Checkup Date _/__/__ Next Appointment __/__/__ √Times Per Day Emergency Medical Information Emergency Contacts 1. Name Phone # 2. Name Phone # My Medical Home 1. Doctors’ Name Phone # 2. Doctors’ Name Phone # 3. Doctors’ Name Phone # 4. Doctors’ Name Phone # 5. Dentist Name Phone # Medical Conditions and History Current Medications: Medication Dose AM Noon PM Medication Dose AM Noon PM Medication Dose AM Noon PM Medication Dose AM Noon PM Allergies Medical Conditions My Medical Home SoonerCare Helpline 800-987-7767 or 711(TDD) Update your status at www.mysoonercare.org Renewal Date Keep a copy of this card in your billfold and your child’s backpack or diaper bag. SCAENG-MEDINFO-2013 www.okhca.org |
| Date created | 2013-04-01 |
| Date modified | 2013-04-01 |