Family Information Notebook (FIN) - Vanderbilt Kennedy Center

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4 Emergency Health Information • Introduction to Emergency Health Information Section 5 • Forms: � Emergency Contact Information 6 -- Important Phone Numbers -- Communication and Ways to Communicate � Medical Information: 7 -- Current Providers -- Current Diagnoses and Conditions � Medications 8 � Baseline Data 9 � Surgery or Procedure Record and Hospital Admissions 10 � Allergies 11 � Latex Allergy Information 12 � Medical Power of Attorney 13 � Suggested Information to Include: 14 -- Emergency Protocol from Doctor -- Insurance Information -- Custody Papers -- Discharge Summaries if Available -- Advance Care Plan © Junior League Family Resource Center 2005
5 INTRODUCTION TO EMERGENCY HEALTH INFORMATION SECTION This section provides information that you or another caregiver might need if there is a medical emergency with your child. It includes: Emergency Contact Information: to provide you or another caregiver with information on how to get in touch with the parents / guardian of your child and how to contact services that may be needed in the event of an emergency. Also included is your family’s primary ways of communicating. Medical Information: pages to show all doctor providers, diagnoses and conditions. Medications: past and present. Baseline Data: significant information about vital signs, labs and tests, prostheses and technological devices, x-rays, and major body systems. Surgeries and Procedures: to record the surgeries and procedures your child has had and when and where the surgeries and procedures took place. The form also provides information on when and why your child has been hospitalized for non-surgical reasons. Allergies: to keep track of any drug, herb, food, fabric, animal, latex, and plant allergies your child may have. Latex Allergy Information: explains how latex exposure may occur. Medical Power of Attorney: to give permission for other people you choose to authorize medical treatment for your child. Suggested Information to Include: -- Emergency Protocol from Doctor (Copy) -- Insurance Information: provide copies of your insurance card(s) and policy numbers, including any TennCare information -- Custody Papers -- Discharge Summaries (if available) -- Advanced Care Plan
Page 1 and 2: 1 Family Information Notebook (FIN)
Page 3: 3 TABLE OF CONTENTS Emergency Healt
Page 7 and 8: CHILD’S NAME: DATE OF BIRTH: CURR
Page 9 and 10: CHILD’S NAME: DATE OF BIRTH: 9 BA
Page 11 and 12: CHILD’S NAME: DATE OF BIRTH: 11 A
Page 13 and 14: 13 MEDICAL POWER OF ATTORNEY I, ___
Page 15 and 16: 15 Health and Development • Intro
Page 17 and 18: CHILD’S NAME: DATE OF BIRTH: 17 M
Page 19 and 20: Eye Exams 19 CHILD’S NAME: DATE O
Page 21 and 22: At home: 21 CHILD’S NAME: DATE OF
Page 23 and 24: 23 SUGGESTED INFORMATION TO INCLUDE
Page 25 and 26: 25 INTRODUCTION TO DAILY ROUTINE Th
Page 27 and 28: CHILD’S NAME: DATE OF BIRTH: 27 S
Page 29 and 30: 1. Equipment: Who provides (agency,
Page 31 and 32: CHILD’S NAME: DATE OF BIRTH: 31 M
Page 33 and 34: CHILD’S NAME: DATE OF BIRTH: 33 P
Page 35 and 36: CHILD’S NAME: DATE OF BIRTH: 35 T
Page 37 and 38: 37 INTRODUCTION TO EDUCATION / SCHO
Page 39 and 40: CHILD’S NAME: DATE OF BIRTH: Name
Page 41 and 42: Doctor Nurse Teacher CHILD’S NAME
Page 43 and 44: � TEIS Evaluations and ISPs � C
Page 45 and 46: INTRODUCTION TO RESOURCES / OPTIONA
Page 47 and 48: Your Child’s Educational Rights:
Page 49 and 50: 49 Kay Flowers, Complaints Consulta
Page 51 and 52: 51 State Special Schools Tennessee
Page 53 and 54: 53 TENNESSEE DEPARTMENT OF CHILDREN
Page 55 and 56:
55 ADDITIONAL EDUCATION AND HEALTH
Page 57 and 58:
57 SPECIAL EDUCATION MEDIATION REQU
Page 59 and 60:
DUE PROCESS HEARING REQUEST FORM TE
Page 61 and 62:
61 INTRODUCTION TO APPENDICES SECTI
Page 63 and 64:
Physical Therapist (PT): a licensed
Page 65 and 66:
QUALITY HEALTH CARE • There are s
Page 67 and 68:
67 Month: _________________________
Page 69 and 70:
F Page Family Resource Center Conta
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Family Information Notebook (FIN) - Vanderbilt Kennedy Center

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