A Vial of Life form is a one-page medical information sheet you fill out and keep on your refrigerator so paramedics can treat you correctly when you cannot speak for yourself. You can download it free from vialoflife.com, print it, fill it in with a black pen, seal it in a plastic bag, stick it to the fridge, and place the two decals that come with the kit on your front door and refrigerator. The whole setup takes about fifteen minutes.
Where to Get the Form
The fastest route is downloading and printing the form directly from vialoflife.com at no cost. The same site lets you create a member account, enter your information online, and print the completed form — also free. If you want the full physical kit, which includes two weatherproof decals and a printed form, an individual kit runs $5 through the website.1Vial of Life. Vial of Life Emergency Medical Form
Many fire departments keep free kits in their station lobbies. Community health centers, senior centers, and Area Agencies on Aging often distribute them too. Call ahead before driving over. Availability varies by department and season.
What to Put on the Form
Use a black ink pen and print clearly. Paramedics read these forms in dim hallways and moving ambulances, so legibility matters more than completeness. If a field does not apply to you, write “N/A” instead of leaving it blank, because an empty space makes a responder wonder whether you skipped it or forgot.
The official form asks for the following:2Vial of Life. Vial of Life Medical Information Form
- Personal identification: full name, date of birth, sex, street address, phone number.
- Physical description: height, weight, hair color, eye color, blood type, and identifying marks like scars or tattoos. These help responders confirm they have the right person’s form.
- Communication and sensory needs: hearing or vision difficulties, dentures, and your primary language if it is not English.
- Current medical conditions: every active diagnosis, such as diabetes, atrial fibrillation, or epilepsy. List the ones that would change how a responder treats you first.
- Past medical conditions: significant prior diagnoses or surgeries, even if resolved. A prior stroke or heart bypass gives context for current symptoms.
- Current medications, dosage, and frequency: every prescription and over-the-counter drug you take regularly, with exact dose and schedule. Responders rely on this section most heavily.
- Allergies to medications: drug allergies that rule out certain treatments. “Penicillin – anaphylaxis” is more useful than just “penicillin.”
- Doctor’s name and phone number: your primary care physician and any key specialists. The ER will contact them for a full clinical history.
- Last hospitalization: where and roughly when.
- Health insurance policy: insurer name and policy number. Paramedics treat first regardless, but this speeds up hospital admissions.
- Special instructions: health directives, religious considerations, organ donor status. If you have a DNR or POLST, note it here and include the document itself.
- Emergency contacts: name, address, phone, and relationship for each person you want notified.
- Pets in home: if you live alone with animals, this alerts responders that a dog or cat may need care. Include someone who can take them on short notice.
Each person in the household fills out a separate form. All the completed forms go into the same kit on the refrigerator.
Where to Store It at Home
Put the completed form inside a clear plastic bag or a sealable plastic vial to protect it from kitchen moisture. Attach the bag to the front of your refrigerator door with tape, a magnet, or adhesive — anywhere a responder will spot it immediately. The refrigerator is the recognized storage location for this program, and EMS crews across the country are trained to check it when they see the decal.
Placing the Decals
The kit comes with two stickers. One goes on your front door, visible to approaching responders. The second goes on the refrigerator near the stored form.3Placer County. Poster – Vial of Life The door decal tells paramedics there is medical information inside before they cross the threshold. The refrigerator decal confirms where to find it. Without both, a responder may never think to look.
A Copy for Your Car
Some Vial of Life programs include a third sticker for your car window. If you are in an accident and cannot communicate, paramedics can check your glove box for the same form you keep at home.4Durham County. Vial of Life Print a second copy of the completed form, fold it, and keep it in the glove compartment. Place the vehicle decal on the driver’s-side window where it is visible from outside.
The vehicle copy matters most for people who travel frequently or spend significant time away from home. Keep it updated along with the refrigerator copy. An outdated medication list in the car can be worse than none at all if it leads to the wrong treatment.
A Backup on Your Phone
The refrigerator form works when you are at home. Your phone is more likely to be with you in a restaurant, at a park, or on a trip. Both iPhone and Android let you create a Medical ID that first responders can view from the lock screen without unlocking the device.
On an iPhone, open the Health app, tap your profile picture, then tap Medical ID. Turn on “Show When Locked” so anyone can access it in an emergency. You can also enable “Share During Emergency Call,” which automatically sends your medical information to emergency services when you call 911 on supported devices.5Apple. Set Up Your Medical ID in the Health App on Your iPhone On most Android phones, the equivalent setting lives under Settings, then Safety and Emergency, then Medical Information. The exact path varies by manufacturer.
Digital IDs are easy to update and always with you, but if the battery dies or the phone is lost, the information vanishes. Keep the physical form as your primary record and treat the phone as a backup for when you are away from home.
Legal Documents to Include
The Vial of Life form captures your medical facts. Legal documents go a step further by telling responders what you want done with those facts when you cannot speak. Three documents are worth adding to the kit.
Do Not Resuscitate Orders
A DNR directs emergency personnel to withhold CPR, intubation, and defibrillation if your heart or breathing stops. It must be signed by you (or your legal surrogate) and your physician to be valid. The exact form and requirements vary by state, and most states have a standardized out-of-hospital DNR that EMS is trained to recognize. A signed DNR from a different state or on a non-standard form may not be honored in the field, so use your state’s official version.
Legible photocopies of a DNR are accepted by EMS personnel in many states. If you keep the original with your attorney or in a safe deposit box, a clear photocopy in the kit will serve the same purpose in those jurisdictions. Check with your local fire department or EMS agency to confirm your state’s rule on copies.
POLST Forms
A POLST (Provider Orders for Life-Sustaining Treatment) is broader than a DNR. Where a DNR addresses only CPR, a POLST covers mechanical ventilation, feeding tubes, antibiotics, hospital transfer, and whether you prefer aggressive treatment or comfort care only.6National POLST Collaborative. National POLST Collaborative – Portable Medical Orders It is a medical order signed by a physician, and health care providers are required to follow it in any setting, whether at home, in an ambulance, or at a hospital.
POLST forms are designed for people with serious illness or advanced frailty, not for generally healthy individuals. Forty-three states and Washington, D.C., have codified POLST programs into state law, though the name varies. Some states call it MOLST, COLST, or MOST.7American Association of Nurse Practitioners. Issues at a Glance – Provider Orders for Life-Sustaining Treatment (POLST) Ask your physician which form your state uses.
Advance Directives and Medical Power of Attorney
An advance directive, sometimes called a living will, records your treatment preferences for future situations when you cannot communicate. A medical power of attorney names a specific person, your health care agent, to make decisions for you if you become incapacitated. Many states combine both into one form.
These documents require formal execution to be legally valid. Requirements differ by state but commonly include your signature, a date, and two adult witnesses. Some states accept notarization as an alternative to witness signatures.8Texas Health and Human Services. Advance Directives Place a copy of each executed document in the kit so that responders and hospital staff can act on your wishes immediately.
Keeping It Updated
An outdated form can do real harm. If your medication list still shows a drug you stopped taking six months ago, a paramedic might avoid a treatment that would actually be safe, or assume an interaction that does not exist. Review the form after every doctor’s appointment or whenever a medication, dosage, or diagnosis changes.9Leon County Government. Vial of LIFE Program
For small changes, cross out the old entry with a single line and write the correction next to it, as long as both the old and new text remain legible. Once the form gets cluttered, print a fresh one. Update the vehicle copy and the phone’s Medical ID at the same time so all three match. A quick check every six months, even when nothing has changed, is a reasonable habit.