Skip to content
Home
Projects
Self-Immunity Check
Golden Hour Management
Give Way To Ambulance
Accident Prevention & Response
Disaster Rescue & Relief Management
Organ & Tissue Donation
Personal Emergency Information Card
Advocacy
Railways
Health Department
Police
Fire Brigade & Traffic Police
MORTH – Road Safety
Organ Donation
MCGM
About Us
Founder’s Message
Partners & Affiliations
Awards & Recognitions
Media Coverage
Testimonials
Blog
Resources
Awareness Material
Videos
Quiz
Presentation
Connect
Volunteer
Donate
Contact Us
Careers
Events
Donate
Personal Emergency Information Card
व्यक्तिगत आपातकालीन जानकारी कार्ड
Select Language / भाषा चुने
*
— Select Here —
English
हिंदी
Instructions while filling out the Personal Emergency Information Card
trans-instructions-li-1
trans-instructions-li-2
trans-instructions-li-3
trans-instructions-li-4
trans-instructions-li-5
trans-instructions-li-6
trans-instructions-li-7
Do watch the video below; it will help you understand why everyone should have their own “Personal Emergency Information Card ”. This will help you understand the importance of each field and what information you should fill out.
Supported by
Our Visitor
Powered By
WPS Visitor Counter
trans-form-heading
trans-personal-information
trans-personal-info-desc
Prefix
*
— Select Here —
trans-prefix-ms
trans-prefix-mst
trans-prefix-mrs
trans-prefix-mr
trans-prefix-dr
Name
*
Name of Father/Husband/Mother
Family Name (Surname)
*
Age (years)
*
Gender
*
— Select Here —
trans-male
trans-female
trans-transgender-male
trans-transgender-female
trans-others
Pincode
*
State
*
District
*
Taluka
*
Residence Address (Line 1)
*
Residence Address (Line 2)
*
Mobile Number
*
Residence Phone Number
Email ID
*
Our Visitor
Powered By
WPS Visitor Counter
trans-form-heading
trans-emergency-contact-heading
trans-emergency-contact-desc
My 1st Emergency Contact Name
*
My 1st Emergency Contact Surname
*
Relationship with Emergency Contact
*
— Select Here —
trans-father
trans-mother
trans-brother
trans-sister
trans-wife
trans-husband
trans-son
trans-daughter
trans-daughter-in-law
trans-son-in-law
trans-uncle
trans-aunty
trans-cousin-brother
trans-cousin-sister
trans-father-in-law
trans-mother-in-law
trans-grand-son
trans-grand-daughter
trans-nephew
trans-niece
trans-neighbour
trans-friend
trans-employee
trans-office-colleague
My 1st Emergency Contact Number
*
My 2nd Emergency Contact Name
*
My 2nd Emergency Contact Surname
*
Relationship with Emergency Contact
*
— Select Here —
trans-father
trans-mother
trans-brother
trans-sister
trans-wife
trans-husband
trans-son
trans-daughter
trans-daughter-in-law
trans-son-in-law
trans-uncle
trans-aunty
trans-cousin-brother
trans-cousin-sister
trans-father-in-law
trans-mother-in-law
trans-grand-son
trans-grand-daughter
trans-nephew
trans-niece
trans-neighbour
trans-friend
trans-employee
trans-office-colleague
My 2nd Emergency Contact Number
*
Our Visitor
Powered By
WPS Visitor Counter
trans-form-heading
trans-medical-info-heading
trans-medical-info-desc
I suffer from diseases (1st)
— Select Here —
trans-cancer
trans-convulsion
trans-Diabetes
trans-heart-problem
trans-high-blood-pressure
trans-low-blood-pressure
trans-none
I suffer from diseases (2nd)
— Select Here —
trans-dialysis
trans-hiv
trans-prostrate-disease
trans-psychiatric-disease
trans-respiratory-disease
trans-thyroid
trans-none
Any Other Disease (3rd)
Any Other Disease (4th)
My Daily Medicine (1st)
My Daily Medicine (2nd)
My Daily Medicine (3rd)
My Daily Medicine (4th)
I’m allergic to this medicine (1st)
— Select Here —
trans-adhesive-tape
trans-anaesthetics-drugs
trans-antibiotics
trans-antitoxin
trans-aspirin
trans-codeine
trans-demerol
trans-emperin
trans-iodine
trans-methiolate
trans-morphine
trans-narcotics-drugs
trans-novocain
trans-pain-killer
trans-penicillin
trans-serums
trans-sulfa-drugs
trans-tetanus
trans-none
I’m allergic to this food or other things (2nd)
— Select Here —
trans-bee-stings
trans-chocolate
trans-eggs
trans-insect-bites
trans-milk
trans-mushroom
trans-not-aware
trans-peanut
trans-sun-exposure
trans-none
Any other allergies (3rd)
Any other allergies (4th)
Our Visitor
Powered By
WPS Visitor Counter
trans-form-heading
trans-other-info-heading
trans-other-info-desc
Select Your Blood Group
*
— Select Here —
trans-a-positive
trans-a-negative
trans-b-positive
trans-b-negative
trans-ab-positive
trans-ab-negative
trans-o-positive
trans-o-negative
trans-bombay-prototype
trans-not-known
Do You Have Medical Insurance?
*
— Select Here —
trans-yes
trans-no
Medical Insurance Company Name
— Select Here —
trans-acko-general-insurance
trans-aditya-birla-insurance
trans-bajaj-allianz-general
trans-care-health-insurance
trans-cholamandalam-ms-general
trans-edelweiss-general
trans-future-generali
trans-go-digit-general
trans-hdfc-ergo-general
trans-icici-lombard-gi
trans-iffco-tokio-general
trans-kotak-mahindra-general
trans-liberty-general
trans-max-bupa-health-insurance
trans-national-insurance
trans-navi-general
trans-niva-bupa-health-insurance
trans-raheja-qbe-general
trans-sbi-general
trans-star-health-allied
trans-tata-aig-general
trans-the-new-india-assurance
trans-the-oriental-insurance
trans-united-india-insurance
trans-universal-sompo-gic
trans-other
Medical Insurance Policy Number
Click your image (enable webcam and click on Take Photo) or choose your existing photo.
Your captured image will appear here…
*
I understand that above information is for my personal use in case of any emergency.
*
Yes, I agree to RADHEE Disaster and Education Foundation
Privacy Policy
and
disclaimer.
Loading…
Donate
Home
Projects
Self-Immunity Check
Golden Hour Management
Give Way To Ambulance
Accident Prevention & Response
Disaster Rescue & Relief Management
Organ & Tissue Donation
Personal Emergency Information Card
Advocacy
Railways
Health Department
Police
Fire Brigade & Traffic Police
MORTH – Road Safety
Organ Donation
MCGM
About Us
Founder’s Message
Partners & Affiliations
Awards & Recognitions
Media Coverage
Testimonials
Blog
Resources
Awareness Material
Videos
Quiz
Presentation
Connect
Volunteer
Donate
Contact Us
Careers
