Emergency Information Form for Children with Special Needs

The American College of Emergency Physicians and the American Academy of Pediatrics are pleased to present the Emergency Information Form (EIF), which can be downloaded from the menu at the bottom of this page.

This important document will assure prompt and appropriate care for Children with Special Health Care Needs (CSHCN). Now, when these patients present to emergency departments or health care professionals with an acute illness or injury, physicians, parents, EMS professionals, and nurses will be able to use the EIF as a tool to transfer critical information.

The EIF will ensure that a child's complicated medical history is concisely summarized and available when it is needed most - when the child presents with an acute health problem at a time when neither parent nor pediatrician is immediately available.

For additional assistance see the Patient Forms section of the American College of Emergency Physicians website.

If you do not wish to fill out the form on the computer, simply print it out without entering anything and complete it by hand.

Emergency Room Medical Form