EMERGENCY CARD

Alexis Santangelo, NP-C
Movement Disorders Center, Department of Neurology, University Hospitals

Dr. Camilla Kilbane
Director, UH Movement Disorders Center, University Hospitals

Critical Parkinson’s Information
I have Parkinson’s Disease

My Name Is: _______________________________________
My DOB Is: _________________________________________

In Case of an Emergency, Please Contact:

Emergency Contact 1:
Name: _____________________________________________
Relationship: ________________________________________
Phone: _____________________________________________

Emergency Contact 2:
Name: _____________________________________________
Relationship: ________________________________________
Phone: _____________________________________________

Emergency Contact – Medical
Neurologist/Doctor: __________________________________
Phone: _____________________________________________

EMERGENCY CARD CONT.

Medications (must be taken ON TIME):

• See medication list (patients/caregivers should carry updated lists)
• No Haldol – avoid dopamine blockers such as antiemetics and antipsychotics unless an emergency, as they can worsen parkinsonism.
• Use ondansetron/Zofran if needed for nausea.

Allergies: __________________________________________

Important Parkinson’s Information

• I must receive my Parkinson’s medications on time. Even short delays can cause serious complications.
• My symptoms may include: dyskinesia, tremor, slowed movement, soft speech or delayed response, stiffness or difficulty walking.
• These are typical of Parkinson’s and are not signs of intoxication or confusion.
• Please allow extra time for me to respond.

Other Notes:

• Swallowing difficulties: ____________________________
• Mobility aid (walker/cane): _________________________
• Other conditions: _________________________________