The information in this file is the complete and exclusive responsibility of the person who owns them (the patient or the patient's legal guardian). The user is responsible for all use of this information and the onus falls on him or her to verify each item of data where appropriate.

EMERGENCY

General info

Date record started :2001-9-9 - 15:32:13 
Date records last updated :2016-8-17 - 13:0:39 
These questions were answered
with the assistance of a doctor (ideal !) :
 
Tel/Mobile 1st pers. to contact :+32 123456789 
Tel/Mobile 2nd pers. to contact :+33 9876543212 
Tel/Mobile 3d pers. to contact :+39 010102035 
Tel/Mobile 4th pers. to contact :+450 21212121 
Tel of family doctor/specialist :+32 987654321 
Fax of the family doctor / specialist : 
Year of birth : (year only)1497 
First letter of NAME: (not mandatory)Mona 
First letter of first name : (not mandatory)Lisa 
Sex :
  Male
  Female
Blood group :AB 
Rhesus
Remarks - insurance :contrat universassistance numéro 123456789
***
contrat bris de vitre numéro
987654321
***
police tout risque
numéro 6574839201
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tél assureur :
+32 4498723678