Rob Blanchard 111111111

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holder Alertag Holder information
  Rob W Blanchard
Born: 2004
Approx Age: 12
123 Onizuka St 12
Austin, CA 97417
(661) 555-5454


NO Epilepsy
NO Seizures
NO Alzheimer's
NO Autism
YES Diabetic
Medications taken for diabeties: insulin
YES Contacts
NO Donor
Bloodtype: O+
Last Tetanus Injection: January of 2005
Marital Status: Seleccione Estado civil...
   
holder ICE Contact #1
  Jane Victoria Aldred
  Phone: (123) 324-1827
Email: janealdred@testsite.com
Relationship: Mother
This contact knows my keycode and will provide access to private personal history
holder Primary Medical Insurance Provider
  Provider: Aflack
Policy #: 238923949432
holder Conditions
  none
holder Treatments
  none
holder Medications
  DIVALPROEX SOD ER 500MG TAB: 2 TABS ORALLY TWICE A DAY DIVALPROEX SOD ER 250MG TAB: 1 TAB ORALLY DAILY (BETWEEN 4-5PM) ABILIFY 20MG TABLET: 1 TAB ORALLY AT BEDTIME CLONAZepam 1MG TAB: 1 TAB ORALLY 3 TIMES A DAY (MDD=3MG) CHLORHEX. GLUC 0.12% SOL 480ML: RINSE 1\2OZ TWICE A DAY DIVALPROEX SOD ER 250MG TAB: 4 TABS (1000MG) ORALLY TWICE A DAY METRONIDAZOLE 0.75% 45GM CREAM: APPLY TOPICALLY TWICE A DAY TO RED AREAS CENTRAL FACE NEUTROGENA 3OZ SPF85 SHEER S/B: APPLY TO EXPOSED SKIN DAILY BEFORE GOING OUT BACITRACIN OINTMENT 1OZ.: APPLY TOPICALLY TWICE A DAY TO AFFECTED AREA(S)
holder Primary Physician
  Jacob Limbscomb
(310) 434-4233

Private Info

Marital Status: Seleccione Estado civil...
Occupation: none
Faith: None
holder List any prescription and non-prescription medications you are taking
  DIVALPROEX SOD ER 500MG TAB: 2 TABS ORALLY TWICE A DAY DIVALPROEX SOD ER 250MG TAB: 1 TAB ORALLY DAILY (BETWEEN 4-5PM) ABILIFY 20MG TABLET: 1 TAB ORALLY AT BEDTIME CLONAZepam 1MG TAB: 1 TAB ORALLY 3 TIMES A DAY (MDD=3MG) CHLORHEX. GLUC 0.12% SOL 480ML: RINSE 1\2OZ TWICE A DAY DIVALPROEX SOD ER 250MG TAB: 4 TABS (1000MG) ORALLY TWICE A DAY METRONIDAZOLE 0.75% 45GM CREAM: APPLY TOPICALLY TWICE A DAY TO RED AREAS CENTRAL FACE NEUTROGENA 3OZ SPF85 SHEER S/B: APPLY TO EXPOSED SKIN DAILY BEFORE GOING OUT BACITRACIN OINTMENT 1OZ.: APPLY TOPICALLY TWICE A DAY TO AFFECTED AREA(S)

Personal History

NO Lung disorder
NO High blood pressure
NO Stroke
NO Nervous disorder
NO Seizure Disorder
NO Alzheimer's
NO Autism
NO Disease or disorder of the digestive tract
NO forms of cancer
NO Disease of the kidney
NO Diabetes
NO Arthritis
NO Hepatitis
NO Malaria
NO Disease or disorder of the blood
NO physical defects or deformity
NO vision or hearing disorders
NO life-threatening conditions
NO contagious disorders
NO psychiatric disorders
NO currently pregnant, or a possibility
YES - Use Tobacco
NO Use Illegal Drugs
NO risk for falls or falling injuries
NO treated, disabled or hospitalized during the last year

Personal Documentation

VIEW Social Security Card