EMERGENCY INFORMATION

Medical History

CURRENT MEDICAL HISTORY

Hypertension

Diabetes

Arthritis

AFib

 

PAST MEDICAL HISTORY

MI - 12/2013

Bypass surgery 12/2013

Hernia Repair 6/1990

MI - 3/1990

Stent placed 3/1990

Cardiac ablation 6/1995 ~ 4/2000 ~ 7/2012

 

ALLERGIES

Penicillin

Rag Weed

MEDICAL HISTORY