Medical Passport

We Make Essential Information & on The Go!

This information is binded to your browser be considerate enough to protect your device

Patient Name: Date of Birth:

Cardiac Diagnosis: Past Surgeries:
Past Catheterizations:

Implanted Devices:

(ICD, Pacemaker, Valve, etc )

Oxygen Saturation:

Resting Heart Rate:

Blood Pressure:

Cardiac Diagnosis:

Hemoglobin/Hematocrit:

Target INR (if on anticoagulants):

Need for Infective Endocaditis:
Yes No

Physical Activity Restrictions:

Genetic Testing:(Special Instrcutions)

Other Major Medical Issues:

Current Medications:

Allergies:

My Pediatric Cardiologist:

My Primary Pediatrician:

My Guardian:

Directive

In case of emergency, if possible, please transport me to:

Columbia University Medical Center
Morgan Stanley Children's Hospital
3959 Broadway
New York, NY 10032