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QR-Health
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Quick Response Health Passport
Name
I like to be known as
Address
I live
By myself
With my family
With staff
The person who knows me best
Phone number
DNA-CPR
I have an advance decision about resuscitation
I do not have an advance decision about resuscitation
Things you must know about me
My GP is
Surgery
Address
I have these medical issues
Asthma
Diabetes
Epilepsy
Heart Disease
High Blood Pressure
Mental Health Issues
Allergies
Kidney Disease
Cancer
Communication
No, I do not have communication issues
Yes, I have communication issues
How well I use and understand speech
Pain - How I show pain and how to support me
Any problems taking medication?
No
Yes
Please provide details
Behavior - Things I do that others might find difficult to manage
Submit
Your QR Code: