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Have you had the experience of consulting with multiple health care providers and struggled with answering questions about your health history or that of a family member?

"Wouldn't it be great to have that information in one place?"

There was a time when a doctor might have known your entire family, visited your home, and known your health and personal history by heart. Although this still may happen, it is also often true that you may have new physicians and health specialists who may not share clinical information in a seamless fashion.

"Start with a three-ring notebook or folder for each family member's health information."

Begin today, by putting your health information in one spot. Include a copy of a recent health history form or complete a master history form. Ask for copies of your health test results.

Information You Can Include in Your Personal Health Record

Click on blue links to print/download documents for your use.

  1. Emergency Information (Who should be notified in an emergency? Include their names, addresses, and how they can be reached. Post the emergency contact Refrigerator Card on your refrigerator.) People with special needs residing in Erie County are welcome to register with their local disaster coordinator/emergency manager - call your municipality.
  2. Health Log (Record health activities & contacts with providers. This can be especially helpful for caregivers who are working with multiple health care providers.)
  3. Health Satisfaction Survey (What areas of health are you satisfied with? What areas could use improvement?)
  4. Health Goals (It's nice to know where you are heading!)
  5. Names of family and friends (Include a listing of household members. Our social support system is essential for our health and well-being.)
  6. Health Care Providers (Include name, address, and phone number for the following: physicians, pharmacists, dentists, chiropractors, osteopaths, nurses, physical therapists, occupational therapists, speech therapists, healers, religious/spiritual leaders, herb experts, homeopaths, counselors, social workers, psychologists, psychiatrists, ophthalmologists, optometrists, reflexologists, exercise specialists, athletic trainers, hearing specialists, acupuncturists, massage experts, dieticians, hospitals, clinics, health maintenance organizations, government agencies, and others.)
  7. Nutritional Matters (Include a diet history and any special dietary needs or plan.) Include any special diet prescribed by a physician, food allergies, and complete a nutritional risk assessment.
  8. Physical Activity (Describe your plan for keeping physically active.) A Physical Activities Workbook is available from AARP, Publication # D561

    Be Active New York State has several fitness programs and information on physical activity.
  9. Immunizations (Include providers, names of immunization, and date of administration.)
  10. Medications (Include any prescription medication, over the counter preparations, vitamins, and herbs, with their names, dosages, the reason you take them, and their effectiveness.)
  11. Screenings & Tests (Include the test, date, result, and the provider. You may include the following: blood pressure, pulse, weight, cholesterol, breast, cervical, or prostate screening, colorectal screening, bone density test results.)
  12. Health History (You may include information about allergies, operations, X-rays, dental visits, eye exams, health and medical exams, and family health history.)

    Because a family health history can have some value, the U.S. Surgeon General has a site allowing your to create and print out a graphical representation of your family's generations and the health disorders that may have moved from one generation to the next. It's available in English, Spanish, and a print version.

  13. Health Insurance Information (you may want to photocopy your insurance card(s) and keep copies here)
  14. Advance Health Care Planning (Include a copy of a completed health care proxy and organ donation information.)

    Visit Advance Health Care Planning for information and links to forms)
  15. Table of Contents (pdf)
  16. Printable cover for your own binder (pdf)

Keep Your Record Handy

The next time you visit a new health care provider, or wonder how you reacted to a past medication, you will easily be able to retrieve the information (even if you are on vacation!) You will be pleasantly surprised to find that you can keep it all together.

Other resources available:

Visit this Agency for Healthcare Research and Quality (AHRQ) Web page to view the "Video on Personal Health Records" or to read the transcript.

Visit this Food and Drug Administration Web page, "My Medicine Record." You can use the record to keep track of your medicine and dietary supplements. The information can be saved on your computer to make any needed changes.

The New York State Health Department has a publication entitled, "Do I have the right to see my medical records? YES". It is available on the New York State Health Department Web Site (Use the search option on the site to locate the title of the brochure.)