Annual Campaign for the Use of the Health Form

By: Sheila Kun RN, BSN, MS, CPN, FCCP

Medical record keeping becomes essential in 2021. When we travelled to Spain in November, we had to prove our vaccination status and verify that we had negative testing on COVID before boarding the flight. Without these records, you can kiss goodbye to your travel plan outside the United States. At home, our record noting the insurance status, health problems and medications, is key to allow people to help you in case if you fall sick. This is especially true when you live in the community; people need to know your allergies, your dietary need and activity limitations.

Fill (or update if you already have one) this form out for yourself, or someone that you really care about. The form will provide essential information to the first rescuer. Do it for yourself and those who take care of you. If you need a Word version of the form, please feel free to email us at

Download PDF form here