Vial of Life

Vial of Life Data Form
Vial of Life Window Decal

During emergencies, patient information is often difficult to obtain. You can help crews respond effectively to a medical emergency in your household by making sure your address is clearly displayed and by following these Vial of Life instructions.

4 Steps to Faster Medical Care

Follow these steps to help emergency personnel respond most effectively to medical emergencies at your home.

1. Fill out the Vial of Life form

  • Fill out the vial form located on this web page. Answer all pertinent questions.
  • Update the information every 3 months or whenever your medical history or medications change.
  • The form can be saved and stored on your computer so that information is easily updated.
  • All information is confidential. We will never disclose or share your healthcare information to those not directly involved in your medical care at our time of service.

2. Place the decal on front of a plastic baggie

  • Place the completed form in a plastic baggie.
  • Consider placing the following other items in the baggie:

Photo of yourself (assures proper identification, if you are home alone)

A copy of your Do Not Resuscitate Orders (DNR) and/or Living Will Declaration

A copy of your Durable Power of Attorney for Healthcare

3. Place the baggie on your refrigerator door

  • Securely tape the plastic baggie to the front of your refrigerator door.
  • Place a decal on the side of your refrigerator or on the front door where anyone responding to an emergency can easy see it.

4. Place the second decal on your front door

Place the decal on the front door (storm door, if possible) so it can easily be seen by anyone

responding to an emergency.



 

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