Individualized Emergency Plan – DIGITAL FORM
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UPDATED 2024
This form is intended to be left in the patient's home and a copy provided to a designated caregiver. It should be filled out by a clinician at the time of admission and then placed in an accessible spot in case of an emergency. This form contains:
• | Priority Code |
• | Patient demographics and medical information |
• | Emergency contacts and phone numbers |
• | Chosen safe place if emergency necessitates patient leave the home |
• | Instruction for a variety of emergency situations |
• | Plus additional considerations including: mobility level, special medical equipment, etc. |
License Agreement
Send completed License Agreements toCustomerSupport@BriggsCorp.com
*SUBSCRIPTION: Form access is licensed for 1-year per agency/facility location. Multiple sites require a quote. This digital form is delivered as a form-fillable PDF and includes 1-year of updates. To receive your electronic file and updates you must complete and return a content license agreement and provide an end-user email address and contact name for file delivery (please allow 2-3 business days for order fulfillment) and provide the facility/agency address. After 1- year, your subscription will automatically renew.
Delivery: Digital*
Digital/electronic merchandise & subscriptions: all digital and electronic products and subscriptions are non-refundable and non-returnable.
*SUBSCRIPTION: Form access is licensed for 1-year per agency/facility location. Multiple sites require a quote. This digital form is delivered as a form-fillable PDF and includes 1-year of updates. To receive your electronic file and updates you must complete and return a content license agreement and provide an end-user email address and contact name for file delivery (please allow 2-3 business days for order fulfillment) and provide the facility/agency address. After 1- year, your subscription will automatically renew.