Important Information
Name: _________________________
Date of Birth: _________________
Emergency Contact: _____________
Phone: ________________________
Medical Information
Current Medications
- List all Parkinson's medications with dosages and timing
- Include all other medications
- Note any medication allergies
Healthcare Team
- Neurologist: _________________ Phone: _____________
- Primary Care: ________________ Phone: _____________
- Pharmacy: ___________________ Phone: _____________
Emergency Instructions
Red Flag Symptoms (Seek Immediate Care)
- Difficulty breathing or chest pain
- Severe falls with injury
- Sudden confusion or loss of consciousness
- Unable to take medications for >12 hours
- Signs of infection with fever
Hospital Kit Checklist
- Current medication list
- 3-day supply of medications
- Medical insurance cards
- Advanced directives
- This emergency plan
- Basic toiletries
Special Instructions
For Emergency Personnel
- Patient has Parkinson's Disease
-
Critical: Parkinson's medications must be given on schedule
- Note any Deep Brain Stimulation (DBS) device
- Check for contraindicated medications
For Caregivers
- Keep this plan visible (e.g., on refrigerator)
- Update medication list regularly
- Review plan every 6 months
- Practice emergency protocols
Additional Resources
- Parkinson's Foundation Helpline: 1-800-4PD-INFO
- Local Support Group Contact: ________________
- Website: www.parkinson.org