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Over 75 pertinentmedical items listedYour personalidentificationQuick reference chart listsblood type, allergies,medicine currently being takenPersonal physician'sname & numberF ill out school, camp,service or job applicationsand insurance formsquickly and accuratelyAmerican- MethodistHealth Services%u2022CARE CARD%u2022John A. Smith100 Park PlaceBrooklyn, NY 11215 I506 Sixth Street Brooklyn. New York 11215 718/780-3000 -------------TH e m e m o D iS T%u00b1 HOSPITAL-^-American%u2014w AMBULANCE & OXYGEN SERVICEWarning stickers for\Microfilm can he read with any 8-1 Ox microscope or microfiche reader It contains emergency data, medical information and authorization for treatmentAmerican Ambulance 718-768-7600%u00a3%u00a3Entire medical history%u25a0 on microfilm sealed into card, Methodist Hospital phonenumber for quick referenceVIssue date shows howcurrent information isive us 5 minutes and we%u2019llsend you the card thatmav save your life.FREE, The Care Card from Methodist Hospitaland American Ambulance Co.This card contains all o f your vital medical information on atiny microfilm that can be read in any Emergency Room ordoctor%u2019s office.The Care Card supplies information Emergency Room personnel may need in an emergency. Important informationabout allergies, blood type, or medical problems that couldsave your life when you may be confused or unable to givethat information.The Care Card Does MoreThe Care Card is just as valuable in everyday situations. It\It reduces time spent filling out forms in hospitals and doctors%u2019 offices. And the card is a ready reference when fillingout forms and applications.Fill out the form below and send it to us today. We recommend that you consult with your doctor to make sure the information is accurate and up-to-date. Within four weeks,you%u2019ll receive your Care Card in the mail. W e%u2019ll also includetwo florescent red stickers - one for the back o f yourdriver%u2019s license, the other for the back of your car%u2019s rearview mirrow - which will alert rescue personnel that you%u2019recarrying the card.Contact us and w e%u2019ll send additional forms for children andother family members.Methodist Hospital and American Ambulanceihe card is absolutely free. We are ieaders in providinghealth care service to the community, and we%u2019re making thiscontribution to better the welfare o f Brooklyn.It takes only five minutes... And that could save your life.Mail to:Daniel G. RowlandDirector o f Development and Public AffairsThe Methodist Hospital of Brooklyn506 Sixth StreetBrooklyn, N .Y . 11215718/780 3370American-Methodist Health ServicesIN STR U C TIO N S :1 Please type or print in black ink (o r all written sections2 Sign all authorizations and have th e m properly witnessed M ino rs must have theirform signed by a parent or gu ard ian3 All sections should be co m p letely filled out If you have doubts about any medicalcondition, consult your physician b e fo re completing the formEM ERG EN C Y M ED IC A L IN F O R M A T IO N ~s iw T; D.%u00bbots.n%u00bb---------------Sir** A60r*M City Stat* Zip Cod#T*t*p*on# NizmO* Soc S*c No WeightStaler* Ration (optional] Employ*! (Co Nam* ary) Pnon* %u2022,Medic# insurance Co and Policy Numb*'Ha** you *v*f M*rt tr*at*d %u2022%u00ab Th* M*modf%u00bb HoapiiaiPtiyvoan 1 Nam* and Phon* NumMrIf C A R D h okJer is a m in o r, p le a s e lis t p a r e n ts e m p lo y e rsY o u r E m p lo y e r -------------------------------------------------------- S p o u se's E m p lo y e rP h o n e N u m b e r -------------------------------------------------------- P ho n e N u m b e r _________________________City/State---------------------------------------------City/State_________________________PCRSONS/NEXT O f KIN TO BE NOTIFIED IN CASE OF EMERGENCY 'N* n* Relationship Phon* NoM E D IC A LIN F O R M A T IO N(Black m boxes completely if applicable to you)%u25a1 Anemia%u25a1 Arthritis%u25a1 Asthma%u25a1 Blind%u25a1 Cancer%u25a1 Cataracts%u25a1 Cerebral Palsy%u25a1 Cirrhosis%u25a1 Contact Lenses%u25a1 Cystic Fibrosis%u25a1 Deaf%u25a1 Diabetes%u25a1 Dentures%u25a1 Emotional Problems%u25a1 Emphysema%u25a1 Epilepsy%u25a1 Glaucoma%u25a1 Heart Condition%u25a1 Hemophilia%u25a1 H e p a titis%u25a1 Hodgkins D isfase%u25a1 Hypertension%u25a1 Hypoglycemia%u25a1 Implanted Pacemaket%u25a1 Kidney Disorder D Mental Illness%u25a1 Mental Retardation%u25a1 Missing Paired Organ%u25a1 Muscular Dystrophy%u25a1 Multiple Sclerosis%u25a1 Mute%u25a1 Myasthenia Gravis%u25a1 On Chemotherapy%u25a1 Paralysis%u25a1 Psychiatric Treatment%u25a1 Rheumatic Fever%u25a1 Rheumatoid Arthritis%u25a1 Sickle Cell Anemia%u25a1 Stroke%u25a1 Tuberculosis%u25a1 U lce r%u25a1 Taking Anticoagulant%u25a1 Taking Cortisone%u25a1 Taking Methadone%u25a1 Taking Steroids%u25a1 Other Medical Problems%u25a1 Other2 _____________________ (__U ST ALL ORE RATIONS (INCLUDE YEAR)1ALLERGIC TO:%u25a1 Anesthetics%u25a1 Antibiotics%u25a1 Aspirin%u25a1 Codeine%u25a1 CortisoneLIST ALL CURRENT MEDICATIONS1_______________ ___2 __________________3 ______________________4 __________________LIST CHRONIC ILLNESSES1____1______________2_____________ ______3 ____________4 ______________________DATE OF LAST IMMUNIZATION D R T _______________________________ _T e ta n u s T o x o idB LO O D TYPE(C heck If known)%u25a1 P o s itiv e %u25a1 N e g a tiv eD O D B%u25a1 A D A BW ould yo u be interested in becom ing aM ethodist H ospital Blood Donor?O Yes %u25a1 NoHave you d o n ated blood w ithin the pastyear?%u25a1 Yes %u25a1 NoA S S U M P T IO N O F RESPO N SIB ILITY FO R C O R R EC TN E SS(Y ou must sign to vaildais)I H E R E B Y C E R T IF Y th at I have read this c o m p le te d form and that all in fo rm atio nre c o rd e d o n this form is tru e, correct and a cc u rate to th e best of m y k n o w led g e an dbelief I a g ree to assu m e co m plete responsibility fo r th e truth, correctness an da c c u ra c y o f that in fo rm a tio n Further, I h ereby a g re e , in d ivid u ally, and on b eh alf ofm y a g e n ts heirs, successo rs, o r assigns, not to assert an y claim s against M e d -C a rdSystem s. T h e M eth o d ist H o spital and A m erican A m b u la n c e an d its e m p lo yees,agents, su b contractors, suppliers, an d /o r e m e rg e n c y personnel, or an y oth eren d o rs in g co m p an y or g ro u p (and their respective officers, directors, em p lo yees,- c c - s o r s . and a ffilia te s) in law or equity fo r lia b ility arisin g from or in c o n n e c tio na) a n y inaccuracy or o m ission of inform ation pro vid ed on this form .b ) th e p e rfo rm an ce o r la c k of perform an ce o f a n y service relating to th e fo rm ofm y M eth odist H o s p ita l and Am erican A m b u la n c e C a re C ard orc) a n y d am ag e to m y M e th o d is t Hospital a n d A m e ric an A m b ulance C a re C a rd (o rits co m po nen ts)234%u25a1 D*m*rol%u25a1 InMct Sting*%u25a1 I V P Oyaa%u25a1 Morphine U Novacame U Panicillmn T e le e .n Tnwmrl%u25a1 Tetracyclma%u25a1 OthtrDale signed Signature____________________WitnessO FF IC E USE O N LYS.Page 28, THE P H O E N IX , October 2,1986