How to use this form
- Press Print or save as PDF below. Choose Save as PDF in the print window to keep a digital copy, or print on A4.
- Print one sheet for each family member.
- Fill in the sections in pencil, so you can update them easily, or print a fresh sheet when things change.
- Keep the sheet at the front of the person's medical folder, and a photo of it on your phone.
- Update it after every doctor visit. Our guide to organising your family's health records explains the rest of the folder.
The form
Family Health Record
One sheet per person. Keep it with the person's medical file and update it after every visit.
Personal details
Full name:
Date of birth:
Blood group:
Emergency contact (name and phone):
ABHA number (optional):
Allergies and long-term conditions
Drug allergies:
Food or other allergies:
Long-term conditions (diabetes, BP, thyroid, etc.):
Past surgeries (what and when):
Current medicines
Medicine, dose and timing:
Prescribed by:
Started on:
Medicine, dose and timing:
Prescribed by:
Started on:
Doctors
Family doctor (name, phone):
Specialist (name, speciality, phone):
Preferred hospital or lab:
Vaccinations
Vaccine and date:
Vaccine and date:
Next due:
Recent visits and tests
Date and reason for visit:
Key findings or advice:
Test name, date and result:
Follow-up date:
For your own records. This sheet does not diagnose or replace a doctor's advice.
Tips for filling it in
- Write medicines by the name printed on the strip or bottle, along with dose and timing.
- For allergies, write what happened, for example rash or breathing trouble, not just the name.
- Leave blank anything you do not know. Add it when you find out.
- For children, record the vaccination date from the card, not from memory.