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πŸ“‹
How to Fill This Out

This Mini Binder helps you and everyone who cares for you understand what you need. Fill in each section with information that's true for you.

πŸ“ž Emergency Contacts

The people to call first in an emergency. Include their name and phone number. Example: "Mom - (555) 123-4567"

ℹ️ Important Information

Doctor / Healthcare: Your doctor's name, clinic phone, and any important health info. Example: "Dr. Sarah Chen at City Clinic, (555) 987-6543, has seizures (takes medication)"

School / Program: Where you spend your days. Example: "Lincoln High School, Room 205, Special Education Coordinator: Mr. Rodriguez"

Medications: What you take and when. Example: "Keppra 500mg twice daily (morning & evening), Vitamins once daily"

Other: Anything else important, like insurance, allergies, or special needs. Example: "Peanut allergy (EpiPen in backpack), Medicaid #12345"

πŸ“… My Daily Routines

What you typically do throughout the day. This helps people know what to expect and what makes you comfortable. Example: "Morning: I wake up at 7am, eat breakfast, shower, watch YouTube for 30 minutes" or "I like routine - same time for meals and bed every day"

❀️ Things I Like & Things I Don't

What brings you joy and what bothers you. This helps everyone know how to support you best. Examples: "I Like: music, playing with my dog, pizza, being outside" or "I Don't Like: loud noises, sudden changes to my schedule, bright lights"

πŸ“ž
Emergency Contacts
The people to call first if something happens to you.

In a real emergency, call 911 first.

Primary caregiver
Secondary contact
ℹ️
Important Information
Doctor / Healthcare
School / Program
Medications
Other
πŸ†˜
What to Do in an Emergency
1. CALL 911
Tell them your name and what's wrong. Describe your symptoms.
2. Tell them how to help you
Tell them anything they need to know about you.
3. Call your primary caregiver
After you or someone calls 911, call the person listed at the top of this page.
πŸ“…
My Daily Routines
Things that help me feel good and stay organized.
Morning
Afternoon
Evening
❀️
Things I Like & Things I Don't
Help people understand what makes me happy.
I Really Like
I Don't Like

Your caregiver keeps this information up to date in the full Emergency Binder.
Last updated: [Date]