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Chilliwack Seniors' Living Well Resource Guide
Personal Record
Name: ____________________________________________________________________
Address: __________________________________________________________________
City: _______________________________________ Postal Code: ________________
Telephone: __________________________________
Care Card #: ____________________ Old Age Security #: _____________________
Current Medications:________________________________________________________
_________________________________________________________________________
Pets in the home:___________________________________________________________
EMERGENCY CONTACTS
Relative: __________________________
Friend: __________________________
Relative:__________________________
Friend: __________________________
Clergy: ___________________________
Doctor: __________________________
Pharmacy: ________________________
Lawyer: __________________________
Ambulance: _______________________
Fire Department: __________________
Police, Fire, Ambulance (Emergency) Phone: 9-1-1
Poison Control Phone: 1-800-567-8911