14 documents every personal medical record needs

October 2, 2015

Maintaining your own medical records can help you and your doctor provide you with better care. It can even save your life. Here's what to include.

14 documents every personal medical record needs

1. Must-Have Information

  • Keep this folder of basic and emergency information at the front of your medical records.
  • It can include any ongoing conditions you have, allergies and do-not-resuscitate requests.

2. Contact information for your health-care team

Get a business card from each doctor and specialist you see. Staple or tape them to a separate sheet of paper and keep it in your files.

3. Your health insurance information

  • Photocopy the front and back of your insurance cards.
  • Add additional data as you acquire it, such as customer service phone numbers, names of helpful staff members and the company's website address.

4. Emergency health information

  • Keep a list of life-threatening allergies or other health conditions that medical personnel should know about immediately in case of an emergency.
  • Put this info into the folder, label it "Emergency info", and make sure it's the first file in your folder of medical records.

5. Emergency contact information

List the names, phone numbers and addresses of relatives and friends who should be contacted in case you or your spouse has a medical emergency.

6. Doctor's reports on medical procedures

If you've had outpatient or inpatient hospital treatments, surgeries or other procedures, ask the institution for copies of records.

7. Test results

Keep copies of x-rays, blood tests and other results in a separate file.

8. Eyeglass prescription

Make a place for a copy of your vision prescriptions.

9. Immunization records

Include current immunizations and, if possible, immunizations from your past.

10. Reports from specialists

Often, doctors cannot release information provided by other physicians. Go back to specialists you've seen for tests or consultations and ask for copies of their reports.

11. Current records

  • Ask each of your current doctors for copies of your health records.
  • If you've seen one doctor for many years, ask if the office can create a summary for you.
  • Include your dentist, eye doctor and any specialists you see on a regular basis.

12. Doctor's Records

  • Keep information about doctor visits, hospital stays, procedures and test results.
  • From now on, ask for copies of reports on tests, procedures and important doctor visits as they happen. That way, your own file will be up-to-date.

13. Copies of advanced-care directives

  • Include information about people who can make medical decisions if you can't, and if you've written out a will.
  • Other important documents include signed a do-not-resuscitate orders and organ donor information.

14. Results of ongoing home testing

  • Keep track of your blood sugar levels, blood pressure, cholesterol levels and other common health measurements. Include tests taken at home, at work, at the doctor's office or elsewhere.
  • This will help you notice trends and provide info you can show your doctor, in case the numbers move in an unexpected direction.

Maintaining your own healthcare records will make it easy for you to provide your doctor with important information — and could even save your life. The best system: The one that's easiest for you to complete and maintain.

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