This PRINTABLE PDF is an Emergency Care Document designed to prepare individuals and families for a range of emergency situations, including cyber attacks, war, societal unrest, and natural disasters. It acts as a comprehensive guide, encompassing essential personal, medical, and contact information, alongside detailed plans for communication, evacuation, and emergency response.
Designed to be filled out, regularly updated, and stored securely yet accessibly, this FUTURE document is a part of your SELF MANAGED INSURANCE PLAN. It empowers individuals and families with a structured plan and critical information, aiming to mitigate risks and improve resilience in times of crisis.
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The PDF is 16 pages (these are just an example of 4 pages in the PDF)
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- Download and Print the PDF (as many times as you’d like)
- Fill it Out (keep the information updated)
- Store it (keep it in a safe place)
Information included in this PDF printable:
General Information
Personal Information Section
- Full Name
- Date of Birth
- Home Address
- Phone Numbers (mobile, home)
- Email Address
Immediate Family Information Section
- Spouse/Partner Name
- Spouse/Partner Date of Birth
- Spouse/Partner Home Address
- Spouse/Partner Phone Numbers (mobile, home)
- Spouse/Partner Email Address
- Child(ren)’s Name
- Child(ren)’s Date of Birth
- Child(ren)’s Home Address
- Child(ren)’s Phone Numbers (mobile, home)
- Child(ren)’s Email Address
Emergency Contacts
- Primary Emergency Contact: Name, relationship, phone number, email, and street address.
- Secondary Emergency Contact(s): Same as above for each additional contact.
Medical Information
- Blood Type
- Allergies (if any)
- Medications (brand name, generic name, dosage, frequency, use/purpose, alt use/purpose)
- Diagnoses (if any)
- Surgeries (if any)
- Implants/Medical Devices (if any)
- Primary Care Physician: Name, contact number, email, and street address.
- Specialized Physician(s): Name, contact number, email, and street address.
- Medical Insurance Information: Policy number, provider contact information.
Account Information
For each important account, include:
- Account Type (Bank, Credit Card, Utilities, Insurance, etc.)
- Account Holder’s Name
- Account Number
- Website for Online Access
- Contact Phone Number
- Login ID or Email (Do not write down passwords)
Digital Security
- Instructions on Handling Cyber Attacks: Guidelines on securing personal data, changing passwords, and whom to contact (e.g., IT professionals, cyber security services).
- Critical Digital Assets: List of important digital files, their locations, and how to secure them.
Essential Documents List
Keep these in a secure yet accessible place, and note their location:
- Passports
- Birth certificates
- Driver’s License/State ID
- Marriage certificate (if applicable)
- Important legal documents (living wills, power of attorney, medical consent forms, prescriptions, etc.)
Home and Property Information
- Inventory of Valuables and Essential Property: For insurance purposes and recovery after an emergency, including photographs or videos of your home and valuables.
- Home Repair and Utility Contacts: List of contacts for emergency repairs and steps on how to secure your property.
Financial Preparedness
- Cash Reserve: Location of emergency cash.
- Access to Funds: Information on how to access bank accounts if digital means are down.
Local Emergency Services
- Local Police Department: Contact information.
- Fire Department: Contact information.
- Nearest Hospital: Address and phone number.
- Poison Control Center: Contact information.
- Nearest Fallout Shelter: Address and phone number.
Communication
Family Communication Plan
- Designated Meeting Place in case of separation without communication means.
- Alternate Communication Methods: If phones are down, list alternative ways to send messages or communicate.
- Out-of-Town Contact: A person not in your immediate area to coordinate messages between separated family members.
- Location Code Words: Use these code words to communicate with family members without giving away key and personal information
- Designated Walkie Talkie Channel
Evacuation Plan
- Routes: Primary and alternate routes out of your area.
- Locations: Designated evacuation centers or safe locations.
- Transportation Means: If personal vehicles are not an option, list alternatives.
Supplies
Food and Water
- Non-Perishable Food: Canned goods, dry grains, freeze dried foods, etc.
- Water Supply: At least one gallon per person per day, for drinking and sanitation.
- Water Purification: Tablets, filters, or boiling methods.
- Storage Locations: Cool, dry place; consider using FIFO (first in, first out) rotation for freshness.
- For Infants/Children: Clean Water, Powdered Formula, Jar Baby Food, Manual Breast Pump, Sterile Milk Storage Bags/Bottles/Jars
- For Pets: Clean Water, Canned Pet Food (longer shelf life), Dry Kibble (shorter shelf life)
Medical Supplies
- First Aid Kit Contents: Bandages, antiseptics, sterile gloves, scissors, tweezers.
- Prescription Medications: Enough supply for an extended period.
- Over-the-Counter Medications: Pain relievers, anti-diarrhea medication, antacids, anti-nausea, antihistamines, etc.
- Glasses/Contact Lenses and Supplies: Lenses, glasses, lens case, contact solution
- Specific Medical Devices: Inhalers, epinephrine injectors, blood sugar monitors, blood pressure monitor, etc.
- Feminine Hygiene Products: Tampson, Sanitary Pads, Menstrual Cups, etc.
Cooking & Heat
- Portable Stoves: Gas, alcohol, or solid fuel stoves, suitable for indoor or outdoor use.
- Propane Stoves and Heaters: Include propane tanks of various sizes; ensure proper ventilation when in use.
- Matches/Lighters: Waterproof matches or lighters stored in a waterproof container; ferro rod.
- Firewood, Kindling, & Firestarters: For use in wood-burning stoves or fireplaces; store in a dry place.
- Insulation Blankets: To retain heat within cooking devices or spaces.
- Alternative Cooking Methods: Solar ovens for sun-powered cooking and kerosene stoves as another fuel option.
- Propane Storage: Safe storage of propane tanks, away from living areas and potential sources of ignition.
- Fuel Reserves: Maintaining an adequate supply of propane, kerosene, and other fuels, with attention to safe storage practices and rotation.
- Carbon Monoxide Detector: To monitor safe levels of CO2 around your cooking devices.
Power Sources
- Batteries: Various sizes for different devices.
- Solar Chargers: For mobile phones and small electronics.
- Generators: Portable generators with fuel or solar-powered options.
- Fuel: Stored safely for generators or stoves.
- Faraday Box/Bag: Protect electronics from an EMP.
Communication Devices
- Radios: Hand-crank or battery-powered NOAA weather radio for updates.
- Satellite Phones: For areas without mobile network coverage.
- GMRS Radios: For short-range communication between family members.
- Extra Batteries or Charging Options for all devices.
Personal Protection & Hunting
- Firearms and Ammunition: Stored securely, with focus on proper use and training.
- Bows and Arrows: Including maintenance tools for long-term use.
- Knives: Multipurpose, including for cooking, utility, and protection.
- Pepper Spray: For non-lethal personal protection.
Regular Review and Practice
- Document Review Schedule: Set reminders to review and update this document regularly (e.g., every 6 months).
- Emergency Drill Dates: Schedule and record dates for family emergency drills to practice evacuation, communication plans, and other procedures.
Important Considerations:
- Keep this document in a secure, but accessible location.
- Consider storing a digital copy in a secure cloud storage that can be accessed from anywhere.
- Regularly update this document to reflect any changes in information.
- Share the existence and location of this document with your primary emergency contact.