Heart Attack Survival Plan

Page Updated: 2-8-2007

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Heart Helath - Heart Attack Survival Plan

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Heart Healthy Diet

Heart Attack Survival Plan

Fill in the information below. Keep this form in a handy place. You may want to photocopy it and keep a copy at home, work, and in your wallet or purse. Share the information with emergency medical personnel and hospital staff.

Your name:

Medicines you are taking:

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10.

Medicines you are allergic to:

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If symptoms stop completely in less than 5 minutes, you should still call your health care provider.

Phone number during office hours:

Phone number after office hours:

Person to contact if you go to the hospital.

Name:

Home phone number:

Work phone number:

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HeartSpring.net assumes no responsibility in treatment or cure of any disease or illness.
The information provided on Heartspring.net is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician.
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