Medical Info

Medical Alerts / Conditions:

Diabetic Type 2

COVID-19

COVID-19 tested?: () Yes( ) No

Result: ( ) Positive() Negative

Date of test:

Medical (RX) Presciptions:

Metformin

Non Prescribed Drugs, Medications, Supplements:

None

Allergies:

None

Blood Type:

Blood Type: O Positive

Emergency Contact - 1:

Name: Wife - Jane Test

Phone: 651 555-5555

Insurance Provider:

Carrier: None

Medical Documents:

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