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Emergency Numbers
Emergency: 911 Fire:
Poison Control: 1-800-222-1222 Pharmacy:
Ambulance:
Police:
Medical Numbers
Pediatrician’s name and #:
Dentist’s name and #:
Specialist’s name and #:
Notes:
www. .com Page __ of __
Health Care Binder
Child Information
Parent Information
Prescriptions
Date Filled: Co-Pay:
Name:
Write the full name that is on container label and the concentration (mg/L) or dosage amount (mg)
Dosing Directions:
Example: 15mls per day before bedtime.
Notes:
Dosing Directions:
Example: 15mls per day before bedtime.
Notes:
Dosing Directions:
Example: 15mls per day before bedtime.
Notes:
Co-Payment/Method of Payment:
Notes:
Co-Payment/Method of Payment:
Notes:
Co-Payment/Method of Payment:
Notes: