Order Medical Memories
Healthcare is a changing landscape and often our health is as well.
The notebook binder system allows for easy access and makes any
changes you might have easy to record and keep current.

The Medical Memories™ Personal Health Record
features an assortment of organized sheets
for recording all aspects of your health information.

ALLERGIES – MEDICAL SUMMARIES 

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"Quick Look" MEDICAL SUMMARIES
This section can be used to quickly summarize your overall health picture and will serve as an easy way to share this valuable information with your health care provider. You can record detailed information in other tabbed sections.

ALLERGY SUMMARY
  • Create a "Quick Look" Summary of ALLERGIES to MEDICATIONS
  • Include allergic reactions to Animals, Environment, Food and Products
  • This vital information could save your life
    • MEDICATIONS – CURRENT SUMMARY
  • Create a "Quick Look" Summary of current medications
  • Include over-the-counter medications, vitamins and supplements
  • Record detailed information in the Medications – Vitamins – Pharmacy section
    • MEDICATIONS – PAST SUMMARY
  • Create a "Quick Look" Summary of past medications
  • Include over-the-counter medications
  • Note if the medications were helpful OR had negative side effects
  • May be useful for future reference in the event of a recurring medical condition
    • MEDICAL CONDITIONS – CURRENT & PAST SUMMARY
  • Create a "Quick Look" Summary of current and past medical conditions
  • A checklist of medical conditions is available in the Medical History section
  • Record detailed information in the Medical Records A-Z section
    • ex. Kidney stones would be detailed on the Kidney – Urinary Tract – Bladder page
    SURGERY SUMMARY – X-RAY – CAT SCAN – MRI Summary
  • Create a "Quick Look" Summary of surgeries and X-rays
  • Record detailed information in the Medical Records A-Z section
    ex. Gall Bladder surgery would be detailed on the Digestive System page
    ex. A MRI of a shoulder would be detailed on the Musculoskeletal System page
    Remember to include summary information on your Emergency Cards
    • EMERGENCY CARDS
  • Cut, Fold and Insert card into a plastic sleeve
  • Use one for a primary residence
  • Use one for a secondary residence
  • List ALLERGIES and MEDICATIONS
  • Include over-the-counter medications, vitamins and supplements
  • List information important to your health
  • Keep cards current
  • See www.shoewallet.com for accessories

    • "Quick Look Medical Summaries"
    Allergy Summary
    Medications – Current Summary
    Medications – Past Summary
    Medical Conditions – Current & Past Summary
    Surgery Summary
    X-ray – CAT Scan – MRI Summary
    Emergency Card

    MEDICAL HISTORY 

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    PERSONAL HEALTH HISTORY
  • Easy Checklist
  • Reduce the Stress of Remembering
  • "Quick Look" & Recall for Office Visits
  • Past & Current Medical Conditions
    • SOCIAL HISTORY
  • Be honest with yourself and your physician
  • Some factors can lead to major health issues
  • Smoking
  • Drug Usage
  • Stress
  • 2nd Hand Smoke
  • Environment
  • Depression
  • Alcohol Consumption
  • Occupational Exposure
  • Weight Issues
    • MALE, FEMALE & INFANT PERSONAL INFORMATION
  • Detailed Baseline Health Assessment
  • Important to share with your health care provider
  • Additional information can be recorded in corresponding sections
  • After 2 years of age, a child will need to have his or her own Medical Memories™
    • VACCINATIONS CHECKLIST
  • Adult booster vaccinations should be kept current
  • Children/Teens vaccination list helpful for school records
  • Travel may require additional vaccinations and proof
  • Refer to the web sites listed in the Resource Guide for vaccine types and schedules
    • FAMILY HEALTH HISTORY
  • Genetic history and illness of family members play an important part in your health
  • Important to share with your health care provider
  • Refer to the web sites listed in the Resource Guide for creating a health history
    • Personal Health History
    Social History
    Male Personal Information
    Female Personal Information
    Infant Personal Information
    Vaccinations – Adults
    Vaccinations – Children/Teens
    Vaccinations – Travel
    Family Health History

    MEDICAL RECORDS A – Z 

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    It is important to record all tests and diagnostic procedures. In the event of a major illness or difficult diagnosis, being able to see the tests you have already completed and the results may provide insight for you and your physician. Test results from diagnostic procedures and physical examinations can be compared with any changes noted.

  • Blood (Tests)
  • Blood Donations
  • Blood Pressure
  • Brain & Nervous System
  • Breast – Mammogram
  • Cancer – Treatment & Therapy Record
  • Dental Record
  • Dental – Continuing Care
  • Dental – Primary Teeth Record & Chart
  • Dental – Permanent Teeth Record & Chart
  • Digestive System
  • Ear – Nose – Throat
  • Ear – Nose – Throat – Common Infections
  • Ear – Hearing Instruments Prescription
  • Endocrine System – Glands – Hormones
  • Eyes – Vision
  • Eyes – Contacts Prescription
  • Eyes – Glasses Prescription
  • Heart (Cardiac) – Blood Vessels
  • Heart (Cardiac) – Cholesterol Guidelines & Cholesterol Record
  • Kidney – Urinary - Bladder
  • Lungs – Respiratory System
  • Musculoskeletal (Muscles – Bones) System
  • Pelvic Exam & Gynecological Disorders – Female
  • Periods – Menstrual Cycle Record – Female
  • Pregnancy – Prenatal Record
  • Prostate – PSA – Testosterone – Male
  • Skin Care
  • Treatment & Therapy Record
  • Treatment & Therapy Record – Alternative
  • Weight & Height Record

    • Blood (Tests)
    Blood Donation Record
    Blood Pressure Record
    Brain – Nervous System
    Breast – Mammogram
    Cancer – Treatment & Therapy Record
    Dental Record
    Dental – Continuing Care
    Dental – Primary Teeth Record & Primary Teeth Chart
    Dental – Permanent Teeth Record & Permanent Teeth Chart
    Digestive System
    Ear – Nose – Throat
    Ear – Nose – Throat – Common Infections
    Ear – Hearing Instruments Prescription
    Endocrine System – Glands – Hormones
    Eyes – Vision
    Eyes – Contacts Prescription
    Eyes – Glasses Prescription
    Heart (Cardiac) – Blood Vessels
    Heart (Cardiac) – Cholesterol Guidelines & Cholesterol Record
    Kidney – Urinary – Bladder
    Lungs – Respiratory System
    Musculoskeletal (Muscles – Bones) System
    Pelvic Exam & Gynecological Disorders – Female
    Periods – Menstrual Cycle Record – Female
    Pregnancy – Prenatal Record
    Prostate – PSA – Testosterone – Male
    Skin Care
    Treatment & Therapy Record
    Treatment & Therapy Record – Alternative
    Weight & Height Record

    MEDICATIONS – VITAMINS – PHARMACY 

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    MEDICATIONS, VITAMINS, MINERALS & HERBS – SUPPLEMENTS
  • Update pages & Emergency Card as needed
  • Space provided for detailed information
  • Include over-the-counter medications
  • Never guess – Be accurate
  • Share information with your health care provider
  • May help eliminate medication errors
  • Read medication instructions and warnings
  • Be aware of risks and side effects of your medications
    • MEDICATION REACTIONS
  • Negative Reactions – Record on Medications – Past Summary page and the Emergency Card
  • Positive Results – Record on Medications – Past Summary page
  • These pages can be found in the Allergies – Medical Summaries Section
    • PHARMACY PREFERENCES
  • Benefits of providing physicians with pharmacy contact information
  • Allows physicians to order prescriptions by phone or fax
  • May help to eliminate medication errors
  • Prescriptions ready upon your arrival
  • Allows prescriptions to be ordered by mail
  • Pharmacists can be a knowledgeable resource
    • Medications
    Additional Information
    Vitamins, Minerals & Herbs
    Supplements
    Pharmacy Preferences

    SCHEDULING – MEDICAL VISITS 

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    CALENDAR
  • Three years of calendars are provided
    • APPOINTMENT SCHEDULE
  • Helpful in scheduling future medical appointments
  • Easy reference for past appointments
    • MEDICAL OFFICE VISITS
  • Record the information about the office visit
  • Include the reason and important comments
  • Record any tests or procedures in the appropriate sections
  • Easy recall of past medical visits
    • HOSPITAL & EMERGENCY ROOM VISITS
  • Record the information about the Hospital or ER visit
  • Include the reason and any important comments
    • HOSPITAL DIARY
  • Helpful for advocates and patients to remain informed
  • Keeps family members up-to-date
  • Useful for leaving messages for family members
  • Useful for leaving questions for physicians or nurses
    • Important to Record:
  • Allergies
  • Blood Pressure
  • Medications
  • Temperature
  • Physicians Visits
  • Names of Staff
  • Phone Numbers
  • Tests & Results
    • Calendar – 2008 – 2010
    Appointment Schedule
    Medical Office Visits
    Hospital & Emergency Room Visits
    Hospital Diary

    PHYSICIANS – HOSPITALS – CAREGIVERS 

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    In 1996, the Health Insurance Portability and Accountability Act (HIPAA) was passed to insure that a patient's medical history and information be kept private.

    Although a very good law, it limits who, besides yourself, can receive and share medical information with your health care provider and staff.

    A consent form signed by you, listing the family and friends that you would like to be involved in your care, will allow those named the authorization to discuss your personal health information with medical personnel. All health care providers and facilities will need a signed consent form.

    PHYSICIANS – HEALTH CARE ASSOCIATE INFORMATION
    NATUROPATHIC DOCTOR INFORMATION
    ALTERNATIVE – HOLISTIC CAREGIVER INFORMATION
    DENTAL – EYE CARE SPECIALIST INFORMATION
  • Record your health care providers' contact information
  • Easy reference for appointment making or for questions
  • Useful when multiple medical specialists are required
  • May include alternative therapies, counselors, therapists, etc.
    • HOSPITALS & SAME DAYCARE INFORMATION
  • Record your preferred medical center contact information
  • Useful when multiple medical services are required
    • EXTENDED CARE INFORMATION
  • Adult Daycare Facility
  • Retirement Facility
  • Assisted Living Facility
  • Nursing Home Facility
    • CAREGIVER INFORMATION
  • Caregiver
  • Home Nursing Care
  • Hospice
  • Hospice Caregivers
    • Physician Information
    Health Care Associate Information
    Naturopathic Doctor Information
    Alternative or Holistic Caregiver Information
    Dental Care Information
    Eye Care Information
    Hospital Information & Same Daycare Information
    Extended Care Information
    Caregiver Information

    PERSONAL INFORMATION – INSURANCE 

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    The information included in this section is for YOUR personal use only until you want or need to share it. Having these pages completed is like having your home office at your fingertips.

    PERSONAL INFORMATION
  • Organizes important information
  • Assists in completing paper work
    • ADVANCE DIRECTIVE
  • Informs your family of your final wishes
  • Reduces stress and worry
  • Study your state law regarding end of life wishes
    • IMPORTANT DOCUMENTS LOCATION
  • Organize documents at home
  • Record document location only in Medical Memories™
  • Place originals in safety deposit box
  • Place extra copies at home or with family for emergencies
  • Photocopy items from your wallet and/or purse
    • INSURANCE & BENEFITS
  • Non-Medicare
  • Primary/Secondary Medical Insurance
    Prescription Benefit Insurance
    Vision Insurance
    Dental Insurance
    Additional Medical Insurance
  • Medicare
    Medicare – Hospital - Part A
    Medicare – Medical - Part B
    Medigap/Supplement Insurance
    Medicare Prescription Insurance - Part D
  • Senior Services Card
  • Cancer, Disability, Life & Long Term Care Insurance
  • Medicaid
    Workers' Compensation
    Veteran Benefits
    • Personal Information
    Advance Directive Information
    Important Documents Location
    Insurance Information
    Non-Medicare:
    Primary/Secondary Medical Insurance
    Prescription Benefit Insurance
    Vision Insurance
    Dental Insurance
    Additional Medical Insurance
    Medicare:
    Medicare – Hospital - Part A
    Medicare – Medical - Part B
    Medigap/Supplement Insurance
    Medicare Prescription Insurance - Part D
    Senior Services Card
    Cancer, Disability, Life & Long Term Care Insurance
    Medicaid
    Workers' Compensation
    Veteran Benefits Information

    RESOURCE GUIDE – WEB SITES 

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    HEALTH GUIDELINES FOR MEN & WOMEN
  • Guidelines and standards suggested by Medical Community
  • Immunizations
  • Routine Checkups
  • Procedures for Early Detection
  • Prevention of Serious Health Risks
  • Schedule may vary according to health status and family history
    • CHILDREN
  • Guidelines and standards are subject to change
  • Consult your pediatrician about a recommended schedule
  • Immunizations
  • Well Baby & Child Visits
  • Fluoride & Dental Care
  • Vision & Hearing Screening
    • GUIDELINES FOR PHYSICAL EXAMINATIONS
  • Be organized
  • Arrive prepared
  • Bring your Medical Memories™
  • Review health guidelines for Men & Women
  • Complete the two page Health Information Summary located in back of binder
  • Make the most of your limited time with health care provider
    • WEB SITES
  • Various health-related web sites included
  • Excellent Information to help educate and to prepare you
  • May help to make you a better advocate for yourself or your family
  • Ask health care providers for web site recommendations
  • Carefully scrutinize web sites for accuracy
  • Government web sites are often more reliable
  • Internet can be accessed from home or local library
  • Be aware that web site addresses may change or become obsolete
    • GENERIC PAGES
  • Generic Form (Blank Page to use for additional medical issues)
  • Use in Medical Records A-Z section or as a Medical Summary page
    • NOTES
  • Blank note pages provided
  • Can be used in any section
    • Health Guidelines for Men
    Health Guidelines for Women
    Guidelines for Physical Examinations
    Web Sites
    Generic Form (Blank Pages)
    Notes (Blank Note Pages)

    HEALTH INFORMATION SUMMARY 

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    The forms in this section will help you prepare for your upcoming medical visit and aid in summarizing important information to discuss with your health care provider.

    FIRST SUMMARY FORM
  • Document the Date of Appointment for recordkeeping on both summary forms
  • List all Physicians that you visit during the appointment
  • Include the Reason for the Appointment
  • Record Recent Developments - Recurring Symptoms - Recent Tests & Diagnosis
    • Use the "Quick Look" Medical Summaries to compliment these forms
  • List Questions & Concerns in order of importance
  • Record Advice & Recommendations
  • Utilize your limited time with physician
  • Do not expect the physician to "discover" the problem
  • Ask for explanations in "lay terms"
  • Record Blood Pressure
  • Pulse
  • Weight
  • Height
    • SECOND SUMMARY FORM
  • Birth Date
  • Allergies
  • Medications – Current and Over-the-Counter
  • Vitamins and Supplements
  • Past Surgeries / Hospitalizations / Dates
  • Social History - Be Honest
  • Immunizations
  • Summarize your Medical Health History
  • Refer to the Medical History section
  • Include Past and Present major Illnesses / Conditions / Age of Onset
  • Copy your Family's Medical Health History located in the Medical History section
  • Or use Blank Note Pages to summarize Major Illnesses / Conditions / Age of Onset
  • If Deceased, also include Cause of Death / Age
  • Share with your physician

    • Keep your health history up-to-date by transferring important information, medications, notes, tests and procedures onto the appropriate pages in your Medical Memories™ Personal Health Record.

    Save completed forms for future reference.

    Health Information Summary for Medical Visits
    Medical Memories™ Contact Information

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