Resident Medical Information Form

Below is the Resident Medical Information Form. This optional form is designed to enhance efficiency on calls and enable Orange County Fire crews to have access to vital information on scene. Please follow the steps below to complete the form.

  1. Click on the Resident Medical Information Form PDF link below
  2. Fill out the form with the most up to date information
  3. Print out two copies of the form (one to remain at the residence & one for E.M.S. professionals to take to the hospital)
  4. Attach applicable DNR / POLST forms

  Download Form

All patient information is voluntarily disclosed by the patient, patient’s representative, or power of attorney and is protected under applicable HIPPA laws to be used in the furtherance of patient care by healthcare professionals only. Once the PDF link is closed the information is not stored anywhere for future use or access.