Personal Information
- Name: _________________
- Date of Birth: _________________
- MS Type: _________________
- Emergency Contact: _________________
- Neurologist: _________________
Emergency Warning Signs
Seek Immediate Medical Attention For:
- Severe relapse symptoms affecting:
- Breathing or swallowing
- Vision (sudden loss or double vision)
- Balance or mobility (severe)
- Mental status changes
- Signs of infection with fever above 101.5°F (38.6°C)
- Chest pain or difficulty breathing
- Severe allergic reactions to medications
Action Steps During Emergency
-
Call 911 if experiencing life-threatening symptoms
- Contact neurologist: [Phone Number]
- Inform emergency responders about:
- MS diagnosis
- Current medications
- Recent steroid treatments
- Any contrast dye allergies
Important Medical Information
Current Medications
- Disease-Modifying Therapy: _________________
- Symptom Management Medications:
Allergies
- List known allergies: _________________
Recent Treatments
- Last steroid course: _________________
- Recent MRIs: _________________
Hospital Preference
- Preferred Hospital: _________________
- Insurance Information: _________________
Additional Instructions
- Keep copy of this plan accessible
- Update medication list regularly
- Wear medical alert bracelet if prescribed
- Keep emergency supplies readily available
Review and update this plan every 6 months with your healthcare provider.