Vial of L.I.F.E. (Lifesaving Information for Emergencies)


Have you ever thought about what your child would do in an emergency situation where you or the adult they were with became unconscious or unresponsive? Would they know how to call 9-1-1? Would they know what to tell the 9-1-1 operator? Would they be able to tell emergency responders the medical information that is needed to save your life? Teaching your child how to do these things is highly encouraged; however, there are some circumstances that just won’t allow for it. Your child may be too young or they may not be able to remember everything. Let’s face it, can you even pronounce some of the medications you take? Can you, as an adult, list the prescriptions and dosage your parents are on from memory? Most likely not; however, there is a simple solution, a Vial of L.I.F.E. Form.Vial Of L.i.f.e. (Lifesaving Information For Emergencies) 1 Daily Mom, Magazine For Families

Vial of L.I.F.E. is a document that provides a person’s basic medical information to medical personnel in the event that you were unable to provide it yourself.


Vial Of L.i.f.e. (Lifesaving Information For Emergencies) 2 Daily Mom, Magazine For Families

Many Fire Departments across the nation have their own Vial of Life Program. Contact your local Fire Department to discover if they participate in a Vial of Life program and how to access their custom Vial of Life Form and decal.

It Could Save Your Life

Vial Of L.i.f.e. (Lifesaving Information For Emergencies) 3 Daily Mom, Magazine For Families

In the event that you fall victim to a medical emergency that leaves you unconscious, unresponsive, or unable to speak, a Vial of Life Form will inform firefighters, paramedics, or any other first responders of your medical condition and personal information. A current and complete form will allow for medical responders to properly treat you without having to rely on information being dictated from a child or other individual who may not be familiar with your health. When you are unable to speak for yourself, or are confused, in pain, scared, or so overwhelmed that you cannot remember pertinent information, the Vial of Life can speak for you.

Vial Of L.i.f.e. (Lifesaving Information For Emergencies) 4 Daily Mom, Magazine For Families

Making Your Vial of Life

1. Print out a Vial of L.I.F.E. form for each person in your family.

Download the Vial of Life form.

2. Fill out the Vial of L.I.F.E. form by answering any questions pertinent to you.

Vial Of L.i.f.e. (Lifesaving Information For Emergencies) 5 Daily Mom, Magazine For Families

3. Place the completed Vial of L.I.F.E. form in a clear, plastic bag such as a sheet protector or Ziploc bag. Make sure the refrigerator is not cluttered and the Vial of Life Form is easily visible to emergency responders. Fire Departments who use Vial of Life will know to check the refrigerator for forms.

Vial Of L.i.f.e. (Lifesaving Information For Emergencies) 6 Daily Mom, Magazine For Families

Vial Of L.i.f.e. (Lifesaving Information For Emergencies) 7 Daily Mom, Magazine For Families

4. Use the Vial of L.I.F.E. decal to secure the form to the front of your refrigerator.

Vial Of L.i.f.e. (Lifesaving Information For Emergencies) 8 Daily Mom, Magazine For Families

Vial Of L.i.f.e. (Lifesaving Information For Emergencies) 9 Daily Mom, Magazine For Families

Vial of Life decals can be ordered or printed for free here.

Important Parts of a Vial of Life Form

Patient Information

Phone Number
Date of Birth
Social Security Number
Primary Language
Hair Color
Eye Color
Blood Type
Hearing or Vision Impairments
Identifying Marks

Health Information

Current Medical Conditions
Past Medical Conditions
Last Hospitalization
Current Medications (include dosage and frequency)
Allergies to Medications
Doctor’s Name and Phone Number
Hospital Preference
Insurance Information

Emergency Contacts

Phone Number
Relationship to You

Additional Information

Date form was completed
Any wishes or special instructions
A current photograph (for proper identification)
Living Will
Do Not Resuscitate Order
A recent copy of your last EKG (if applicable)

Emergency medical responders will keep your information safe and secure. They will not share your information, and your form will stay with you during treatment and in your possession if transported to an emergency care facility where it will be given to the hospital care provider.

Everyone Will Benefit

Although the Vial of Life Project is sponsored by “Senior Safety”, a medical alert system for seniors, it is encouraged that individuals of all ages in both good or poor health complete a Vial of Life form.


If you have a child who takes prescription medications or has a medical condition, complete a Vial of Life form for them. You may not always be with your child and instead of trying to explain your child’s health to a different adult every time you are not with them, just advise the adult or guardian that your child has a Vial of Life form and it can be found in a place such as their backpack or pocket in the event of a medical emergency.


Even the healthiest of people with no history of medical issues may experience a medical emergency that affects their ability to provide lifesaving information to medical providers. A Vial of Life form can also be kept in a wallet, purse, or the glove box of your vehicle.


Seniors experience many changes in their health. Doctors frequently alter medications and dosage for elderly adults. It is important to keep the Vial of Life form updated as any medical changes occur. has the option to create a free membership which will allow you to store your information online securely and privately. If any changes need to be made to the form, it can be done online making the necessary changes to a specific section without having to rewrite the entire form.
For more information on ways to ensure you and your family receive proper medical care, read about Finding the Right Physicians for Your Family.

This post is meant for educational purposes only. It is not intended to replace medical advice from your physician, doctor, or health care professional. Please read our terms of use for more information.

Sources: Vial of Life Project
Photo Credits: Sasha Staton, Pixabay



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Sasha, mother of one, never has a dull moment with her wild child and prefers it that way! Previously a law enforcement officer, she is now the spokesperson for a fire department. Sasha lives in Daytona Beach, Florida and enjoys running, shopping, and pool parties.

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