ER GO-BAG — 1-PAGE CHECKLIST (Caregiver)

Keep by the door. Grab first. Update every 3–6 months.
Name: ________ DOB: ________ MRN (if any): ________

A) MEDICAL + LEGAL (Clear folder, front pocket)

Medication list (name / dose / schedule)

Allergies list (meds / food / latex)

Insurance card copy + ID copy

DNR copy (if applicable)

POA / Health Care Proxy copy (if applicable)

Baseline note: “What’s normal on a good day”

Recent test summaries (last 6–12 months: EKG / labs / imaging)

B) CONTACTS (Paper copy — don’t rely on phone)

Primary doctor: ___________________ Ph: _______________

Specialist(s): _____________________ Ph: _______________

Pharmacy: _________________________ Ph: _______________

Emergency contact #1: _____________ Ph: _______________

Emergency contact #2: _____________ Ph: _______________

C) TODAY LOG (Fill in during an emergency)

Last meds taken: ____________ Time: ________

Missed meds today? ☐ No ☐ Yes: _________________________

Last meal/snack: ____________ Time: ________

Baseline change noticed: ☐ No ☐ Yes: ____________________

D) COMMUNICATION / BEHAVIOR (1 page max)

Trigger/behavior note (dementia/autism/Parkinson’s, etc.)

Sundowning / nighttime confusion

Fear of restraints / needles / male staff

Pain response unusual (over/under)

Best calming approach: _______________________________

E) COMFORT + CARE NEEDS

Phone charger + power bank

Snacks + water

Wet wipes + tissues + hand lotion

Spare underwear / briefs / diapers

Glasses / hearing aids + labeled case

One familiar item (scarf/blanket/photo)

F) CAREGIVER KIT (Do not skip)

Extra T-shirt

Your meds (pain / stomach / migraine)

Mints or caffeine

Small cash + parking/coins (if needed)

Label the bag: “ER GO-BAG — GRAB FIRST”
Caregivers’ rule: This bag prevents chaos.