Tracks To Tomorrow (TTT) Medical Form for Everyone

[TTTGroup]

This will be the standard medical forum used on every TTT Activity, Event and Overland Travel event. This form can be used by anybody any time; it may save your life. If it does not you will not know about it.

Why do we need this? We never plan our day with an emergency or accident, but it can happen. If and accident happens we do not know all of the information about you. In case of an emergency, having this medical information written down and with you will help first responder's and medical personal save your life. If you are someplace on your own and in an accident and cannot communicate with first responders or doctors they will look for information about you. This could be your drivers license, vehicle registration, insurance card or similar type of information. They generally will check your glove box or console.

Plain and simple - if you do not want to have this for yourself that is fine for you. We do not need to worry about you. If you do not want to have it, Stay Home! This is not a request it is a TTT requirement for an activity. If you do not like this then do not ask to join the activity. Straight to the point! Something happens to you that with proper knowledge could have been avoided you make us feel bad. All because you were too lazy to share the information with people who you then need to depend on for help. Why should we care about you when you do not care about yourself. The trouble is we do care about you. So do it for us, even if you do not want to do it for yourself.

Your personal medical information is yours and we respect that. For this reason we request that your medical information be put in a sealed envelope. It is your responsibility to inform more than one person in the group where it is located. This is in case you are unable to inform others of the location during an emergency. Only then will we use it.

For your contacts; They need to be notified that they are on your contact list. They need to know that in an emergency they will be contacted. This would not be the time for then to learn that they are on your contact list.

If you do not want to include your health insurance information on the form you may want to give it to your contacts. That way, if we need the information your contact will have it.

If you do this once you can always have it in your vehicle. Only when the information changes do you need to update the form. It is good to review the information prior to any trip. This is always good to have in your vehicle all of the times. You could be in an accident around your town and this could save your life!

Copy from below the line or download the form here. Fill it out, put it in an envelope and seal it. Label it with your “Name” and “Medical Information” on the outside of the envelope.

 

[TTTGroup]

TTT Medical Information Form
Last Updated and checked on: __/__/____​

Your Personal medical information
Name:
Date of birth:
Blood type:
Address:

Phone #:

Vehicle description: Lic. Plate #:
Year Make, model and color:
Identification description:

Emergency Contact Information
First person to contact
Name:
Relationship:
Address:

Phone #:
Email:

Second person to contact
Name:
Relationship:
Address:

Phone #:
Email:

Third person to contact
Name:
Relationship:
Address:

Phone #:
Email:

Prescription Medications you take
Name:
Dosage:
Frequency:

Name:
Dosage:
Frequency:

Name:
Dosage:
Frequency:

Name:
Dosage:
Frequency:

Your Doctors
Name:
Specialty:
Phone:

Name:
Specialty:
Phone:

Nonprescription Medications you take

Name and dose:
Name and dose:
Name and dose:

Relevant Medical Issues & dates
1.
2.
3.
4.

Allergies to
Medications:
Foods:
Animals:
Plants:

Recreational drugs you take:

Health Insurance Primary
Company Plan Name:
Phone Number
Member Number:
Other Numbers:

Health Insurance Secondary
Company / Group Plan Name:
Phone Number
Member Number:
Other Numbers:

Do you have a D. N. R. Form?
Filled out and on file at:

 

[TTTGroup]

If you need more room to list things write “Medical Personal check back side for additional information” on the bottom of the form. On the back side you can provide any additional information that will be used to allow the best treatment, if you are unable to communicate. The more information that is given the more precise the treatment can be.

As a suggestion, if you are traveling to different countries. You can use your computer and translate your information in the language of that country. Just saying that this is about your life, you do whatever you want.

About privacy of your information. If someone broke into your vehicle they could have access to some of your personal information.
For this reason we did not include your Social Security/Medicare numbers. This is actually important for the people who are on Medicare. This may be important for your contact people to have in the information that you leave with them. If the need comes to where you need to have this information they will have access to it for you.