IMPLANTED CARDIOVERTER DEFIBRILLATOR (ICD) IDENTIFICATION - WALLET CARD

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Cut this card out and keep in your wallet for use when you are
traveling or away from home.
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ICD IDENTIFICATION CARD
Name_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Address _______________
Cit_
y _ _ __ State _ _ _ _Zip code_ __
Phone Blood Typ_
e _ _ _
_
I'm wearing an Implanted Cardioverter Defibrillator (ICD).
In an emergency, please contact...
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Doctor
Phone
Address
City State Zip code
Hospital
Hospital Phone
Hospital Address
City State Zip code

r-- fold
Type of ICD
_ __ _ _ _ _ _ _ _ _ _ _
Type of leads ______________
Manufacturer_ _ _ _ _ _ _ _ _ _ _ _
_
Date of implan._____________
Paced rate ______________
Model _______________
Serial Number _____________

© American Heart Association, Inc.