Medical Condition:
Description of medical condition: (Triggers- if applicable, preventative actions)

Signs and symptoms:	Medication
Name	Frequency	Dose	Method	Possible side effects

First Aid / Emergency Treatment	Phone 000 for an ambulance

Comments

Emergency contact name:
Phone:

Doctor / specialist name:
Phone:	Date*:	Signature:

*This Medical Management Plan must be reviewed when medical needs change or every 12-18 months.