(Immediate Critical Emergency – Fact Sheet)

Date of information: February 2025

Prepared for: Emergency services / First responders / Medical personnel

Patient Identification & Core ICE Information

Full name and surname: [Please insert full name here – not provided]

Current address: [Please insert current residential address – not provided]

Age: 68 years

Blood type: A positive (A+)

Critical Medical Alerts

• Allergies: Penicillin – allergic (avoid all penicillin-class antibiotics and derivatives)
• Do Not Resuscitate (DNR): Yes / No – [not clearly specified – urgent clarification needed from patient / legal representative / advance directive]
• HIV status: Negative
• Chronic medication: None reported

Important Medical Conditions

• Mild dementia
→ May affect ability to provide accurate history
→ May have memory gaps, confusion, or difficulty following complex instructions
→ Best to speak slowly, calmly, use short sentences, and confirm understanding

Emergency Contact

Emergency contact person: [Name not provided – please complete]
Relationship to patient: [Not provided – e.g. spouse / daughter / son / brother / friend / carer]
Contact phone number(s): [Not provided – critical field]

Quick Summary – First Responder Alert
• 68-year-old patient
• Penicillin allergy – important
• Mild dementia – expect possible confusion / memory issues
• No chronic daily medication
• HIV negative
• Blood group A+
• DNR status unclear – please urgently check for any bracelet, wallet card, legal document or family confirmation

Missing / Urgent Information Still Needed

1. Full legal name and surname
2. Exact current address
3. Name and phone number of emergency contact person
4. Clear confirmation of DNR status (yes / no / documented / verbal only)
5. Any other known allergies (food, drugs, latex, etc.)
6. Any previous major surgeries or hospitalisations
7. Regular doctor / neurologist / geriatrician name & contact (if known)