My Personal Medical Journal by jumandmae

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               My Personal Medical Journal
                          and
                Vital Information Book




                        Journal I (Newborn to age 12)

This is my personal medical journal. It keeps track of my illnesses, injuries,
hospitalizations, medications, appointments, immunizations, the medical
          history of my immediate family, and much, much more.


               In the event I can’t speak for myself,
 My Personal Medical Journal and Vital Information Book will do the
                          talking for me.
                    The Me You See



                            (Click to add or change picture)




               My Personal Medical Journal
                            and
            Vital Information Book for the Year:



This book belongs to
If you find it, please contact my parents by phone:
or Email:
           My Personal Medical Journal
                      and
            Vital Information Book




This is an easy way to create a personalized medical and health
report with up-to-date information. This journal and information
book can be shared with healthcare professionals and family
members. It can be a valuable tool for assessing injuries and medical
conditions in emergency and healthcare situations.


                            Copyright 2006
                          All Rights Reserved

                              Published by
                      New World Enterprises, LLC
                         Post Office Box 1534
                       Fayetteville, Georgia 30214
                            ISBN: 978-1-888527-12-4




                             Table of Contents


Introduction                                          Page 1
Benefits                                              Page 2
All About Me                                          Page 3
In Case of Emergency                                  Page 4
Vital Information                                     Page 5
Schedule of Present Medications and Vitamins           Page 6
Doctor’s Appointments                                 Page 7
Dentist Appointments                                   Page 19
My Pediatrician                                        Page 23
Call in a Specialist                                   Page 25
Hospitalizations and Surgeries                         Page 28
Annual Exams and Check-Ups                            Page 30
Immunizations                                          Page 33
The Day I was Born                                     Page 35
My Medical History                                     Page 36
My Family Medical History                              Page 41
Health Notes                                           Page 47
Record of Healthcare Expenses                          Page 49
                            Introduction

This is My Personal Medical Journal and Vital Information Book.
It could literally help save my life or the life of someone I love. It
contains my medical information and other vital information for one
full year. It also contains important information about my family
medical history.

It is a Must for me in case of an accident or medical emergency. It
provides paramedics, doctors, nurses, and other medical professionals
with vital information that could be essential to my care and
recovery. It is a necessary part of any Survival/Emergency Kit. In
case of a disaster wherein I am in an emergency evacuation, my
personal medical information can be taken with me.

This Personal Medical Journal contains a month-by-month record of
my personal medical information, doctor and dentist visits and
appointments, medications, prescriptions, vitamins, and Much,
Much More.


                 In the event I can’t speak for myself,
   My Personal Medical Journal and Vital Information Book can do the
                            talking for me.
  Benefits of My Personal Medical Journal and Vital Information
                             Book

If I am unconscious or unable to speak due to an accident, medical condition, handicap,
or any other reason, this book can provide Medical Responders with the following vital
medical information that could save my life.

   • Existing conditions, illnesses, or injuries (Examples: heart problems, physical
     disabilities, diabetes, respiratory problems, allergic reactions, etc.)
   • Emergency Contacts
   • Primary Doctors
   • Blood Type
   • Special Needs (kidney dialysis, insulin, etc.)
   • Medications (prescription, nonprescription)
   • Special Devices (such as pacemakers, etc.)
   • My Medical History
   • My Family Medical History
   • Medical Insurance Information
   • Dental Insurance Information
   • And Much, Much More

It is ideal
       •   for doctor and dentist visits,
       •   for travel in town,
       •   for travel out of state ,
       •   for travel out of the country,
       •   for vacations,
       •   and for providing medical protection. Give it as much care as an insurance
           policy.
                             All About Me
Name:
Address:
City, State, Zip Code:
Home Phone Number:                        Cell Phone:
Date of Birth:
Place of Birth:
City and State:
Age:                     Weight:               Height:
Color of Eyes:           Color of Hair:        Nationality:
Mother:                                   Phone Number:
Address:
City, State, Zip Code:
Mother’s Employer:                        Work Number:
Work Address:
Father:                                   Phone Number:
Address:
City, State, Zip Code:
Father’s Employer:                        Work Number:
Work Address:
Legal Guardian:                           Phone Number:
Address:
City, State, Zip Code:
Guardian Employer:                        Work Number:
Work Address:
Daycare:                                  Phone Number:
Address:                                  Contact Person:
School:                                   Phone Number:
Address:                                  Principal:
Grandparents:                             Phone Number:
Address:
Notes/Comments:
                  In Case of Emergency



                        Please Notify
Name:
Relationship:
Home Phone:                   Cell Phone Number:
Name:
Relationship:
Home Phone:                    Cell Number:
Medical Insurance:            Phone Number:
Address:
Member Number:                Group Number:
Medicaid Number:              Phone Number:
Medicare Number:              Phone Number:
Other Medical Number:         Phone Number:
Primary Doctor:
Address:
Office Number:            Emergency Number:
Dentist
Address
Office Number:            Emergency Number:
Dental Insurance:             Phone Number:
Address:
Policy Number:                  ID Number:
Hospital Preferred:           Phone Number:
Address:
Notes/Comments:
                             Vital Information



Existing Illness(es) and/or Medical Condition(s):



Current Medication(s) and Dosage(s):



Allergies: (Prescription):

Allergies: (Nonprescription, i.e. insect stings, food):

Current Treatment:

Special Medical Needs:




Primary Doctors for Existing Illness(es) and/or Medical Condition(s):
Dr.                                   Phone Number:
Dr.                                   Phone Number:
Dr.                                   Phone Number:
Blood Type:              Blood Donor:                Date:
Religious Preference:
Organ Donor:
Important Medical Notes/Comments
         Schedule of Present Medications and Vitamins



Breakfast
Medications/Vitamins      Dosage               Treatment of




Lunch
Medications/Vitamins      Dosage               Treatment of




Dinner
Medications/Vitamins      Dosage               Treatment of




Bedtime
Dr.                            Phone Number:
Dr.                            Phone Number:
Pharmacist:                    Phone Number:
Notes/Comments:
                     January Appointments


Date:                                     Time:
Doctor:                           Phone Number:
Address:
Reason for Visit:

Weight:                Height:              Blood Pressure:
Heart Rate:            Temperature:
Diagnosis:
Prognosis:
Prescribed Medication:


Notes/Comments:

***************************************************
Date:                                     Time:
Doctor:                           Phone Number:
Address:
Reason for Visit:

Weight:                Height:              Blood Pressure:
Heart Rate:            Temperature:
Diagnosis:
Prognosis:
Prescribed Medication:


Notes/Comments:
                     February Appointments


Date:                                     Time:
Doctor:                           Phone Number:
Address:
Reason for Visit:

Weight:                Height:              Blood Pressure:
Heart Rate:            Temperature:
Diagnosis:
Prognosis:
Prescribed Medication:


Notes/Comments:

***************************************************
Date:                                     Time:
Doctor:                           Phone Number:
Address:
Reason for Visit:

Weight:                Height:              Blood Pressure:
Heart Rate:            Temperature:
Diagnosis:
Prognosis:
Prescribed Medication:


Notes/Comments:
                      March Appointments


Date:                                     Time:
Doctor:                           Phone Number:
Address:
Reason for Visit:

Weight:                Height:              Blood Pressure:
Heart Rate:            Temperature:
Diagnosis:
Prognosis:
Prescribed Medication:


Notes/Comments:

***************************************************
Date:                                     Time:
Doctor:                           Phone Number:
Address:
Reason for Visit:

Weight:                Height:              Blood Pressure:
Heart Rate:            Temperature:
Diagnosis:
Prognosis:
Prescribed Medication:


Notes/Comments:
                       April Appointments


Date:                                     Time:
Doctor:                           Phone Number:
Address:
Reason for Visit:

Weight:                Height:              Blood Pressure:
Heart Rate:            Temperature:
Diagnosis:
Prognosis:
Prescribed Medication:


Notes/Comments:

***************************************************
Date:                                     Time:
Doctor:                           Phone Number:
Address:
Reason for Visit:

Weight:                Height:              Blood Pressure:
Heart Rate:            Temperature:
Diagnosis:
Prognosis:
Prescribed Medication:


Notes/Comments:
                       May Appointments



Date:                                     Time:
Doctor:                           Phone Number:
Address:
Reason for Visit:

Weight:                Height:              Blood Pressure:
Heart Rate:            Temperature:
Diagnosis:
Prognosis:
Prescribed Medication:


Notes/Comments:

***************************************************
Date:                                     Time:
Doctor:                           Phone Number:
Address:
Reason for Visit:

Weight:                Height:              Blood Pressure:
Heart Rate:            Temperature:
Diagnosis:
Prognosis:
Prescribed Medication:


Notes/Comments:
                       June Appointments


Date:                                     Time:
Doctor:                           Phone Number:
Address:
Reason for Visit:

Weight:                Height:              Blood Pressure:
Heart Rate:            Temperature:
Diagnosis:
Prognosis:
Prescribed Medication:


Notes/Comments:

***************************************************
Date:                                     Time:
Doctor:                           Phone Number:
Address:
Reason for Visit:

Weight:                Height:              Blood Pressure:
Heart Rate:            Temperature:
Diagnosis:
Prognosis:
Prescribed Medication:


Notes/Comments:
                       July Appointments



Date:                                     Time:
Doctor:                           Phone Number:
Address:
Reason for Visit:

Weight:                Height:              Blood Pressure:
Heart Rate:            Temperature:
Diagnosis:
Prognosis:
Prescribed Medication:


Notes/Comments:

***************************************************
Date:                                     Time:
Doctor:                           Phone Number:
Address:
Reason for Visit:

Weight:                Height:              Blood Pressure:
Heart Rate:            Temperature:
Diagnosis:
Prognosis:
Prescribed Medication:


Notes/Comments:
                      August Appointments



Date:                                     Time:
Doctor:                           Phone Number:
Address:
Reason for Visit:

Weight:                Height:              Blood Pressure:
Heart Rate:            Temperature:
Diagnosis:
Prognosis:
Prescribed Medication:


Notes/Comments:

***************************************************
Date:                                     Time:
Doctor:                           Phone Number:
Address:
Reason for Visit:

Weight:                Height:              Blood Pressure:
Heart Rate:            Temperature:
Diagnosis:
Prognosis:
Prescribed Medication:


Notes/Comments:
                    September Appointments


Date:                                     Time:
Doctor:                           Phone Number:
Address:
Reason for Visit:

Weight:                Height:              Blood Pressure:
Heart Rate:            Temperature:
Diagnosis:
Prognosis:
Prescribed Medication:


Notes/Comments:

***************************************************
Date:                                     Time:
Doctor:                           Phone Number:
Address:
Reason for Visit:

Weight:                Height:              Blood Pressure:
Heart Rate:            Temperature:
Diagnosis:
Prognosis:
Prescribed Medication:


Notes/Comments:
                     October Appointments


Date:                                     Time:
Doctor:                           Phone Number:
Address:
Reason for Visit:

Weight:                Height:              Blood Pressure:
Heart Rate:            Temperature:
Diagnosis:
Prognosis:
Prescribed Medication:


Notes/Comments:

***************************************************
Date:                                     Time:
Doctor:                           Phone Number:
Address:
Reason for Visit:

Weight:                Height:              Blood Pressure:
Heart Rate:            Temperature:
Diagnosis:
Prognosis:
Prescribed Medication:


Notes/Comments:
                    November Appointments



Date:                                     Time:
Doctor:                           Phone Number:
Address:
Reason for Visit:

Weight:                Height:              Blood Pressure:
Heart Rate:            Temperature:
Diagnosis:
Prognosis:
Prescribed Medication:


Notes/Comments:

***************************************************
Date:                                     Time:
Doctor:                           Phone Number:
Address:
Reason for Visit:

Weight:                Height:              Blood Pressure:
Heart Rate:            Temperature:
Diagnosis:
Prognosis:
Prescribed Medication:


Notes/Comments:
                    December Appointments



Date:                                     Time:
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