The Health and Medical Module
A working medical record — medications, allergies, conditions, providers, insurance, advance directives, and HIPAA authorizations — plus an emergency-ready Family Guide.
Text file — the flexible one. Use it as-is, open it in any editor, or paste it into an AI tool to reshape the blank form to fit your family: rename a field, add a row, drop one you don't need.
Print / PDF — the ready-to-use one. Print it and fill it in by hand, or choose Save as PDF and complete it in your own offline PDF app. Either way it stays with you — the finished Secure Guide template goes inside your Vault.
One rule: only ever give an AI tool the blank template. Never paste your real information — passwords, account numbers, anything you'd keep secret — into an AI tool, an online service, or anywhere outside your own Vault. Customizing an empty form is fine; filling it in happens privately, offline. That's the same rule this site follows: nothing sensitive ever leaves your hands.
Secure Guide Starter Template
Store this inside your Vault. Record the date of the last review at the top, then keep each section current.
| Name | Dosage | Frequency | Prescribing Provider | Pharmacy |
|---|---|---|---|---|
| Substance | Reaction |
|---|---|
| Condition | Managing Provider | Notes |
|---|---|---|
| Role | Name | Practice | Phone | Patient Portal |
|---|---|---|---|---|
Patient portal credentials are stored in The Vault.
| Type | Carrier | Plan Name | Member ID | Group # | Member Services |
|---|---|---|---|---|---|
Insurance portal credentials are stored in The Vault.
| Document | Date Executed | Storage Location | Who Has Copies |
|---|---|---|---|
See the Estate Plan Module for formal legal context.
| Authorized Person | Relationship | On File With | Date Authorized |
|---|---|---|---|
Family Guide Starter Template
For use by family members, caregivers, or first responders. This template contains no sensitive credentials.
Any context relevant to emergencies or ongoing care.