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Courtesy of

 John D Doe  DOB: 05/29/1949
 115 Main St.
 Any City, Louisiana 71000
 318- 555-0000   318-555-5214  Blood Type:O-
 Emergency Contacts:
 Mary Doe-Wife  318-555-1212   318-355-0011 Cell
 Jane Biggs-Daughter  318-555-3333    318-555-0081 Cell
 Frank Smith, M.D.   318-555-5555   
 Jane Kelly, M.D.   318-555-6666   
 St.Lukes Hospital- Any City, LA
 Medical Conditions:
- Type 1 Diabetic  High Blood Pressure  Back Pain   DVT  Right Leg  Kidney Stones  Medtronic Pacemaker
  Wear Contact Lens          
 Altace 5 - MG 1xDay   Coumadin 5MG-  1xDay
  Amaryl 1 Tab Loritab 25 MG   1-3xday  Lopressor 50MG-1Xday  Altace 2.5MG-  1xday
 Allergies: /Other Info.
 Sulfa Drugs,   Living Will  Organ Donor

 -Card Printed:  Courtesy of

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