Harborwren · Blank caregiver worksheet
Emergency Info Sheet
Complete on paper. Keep this sheet secure and share only when needed.
Person and document references
Use document names, insurer references, phone numbers, and secure storage locations. Keep original records separate.
Person’s name
Name as it appears on an identity document
Identity documents
Which ID, passport, or birth record is available, and where is it kept? Do not write full ID numbers.
Health insurance
Carrier or plan reference, service phone, and card location
Dental insurance
Carrier or plan reference, service phone, and card location
Property insurance
Carrier or policy reference, contact phone, and secure policy location
Emergency care contacts
Add names and numbers to this sheet and to the phone. Confirm addresses and after-hours details when you review it.
Primary-care provider
Provider or clinic, phone, and after-hours number if available
Nearest emergency department
Hospital or department name, address, and phone
Nurse advice line
Name or service and phone number
Urgent-care clinic
Clinic name, address, and phone
Walk-in clinic
Clinic name, address, and phone