The Vial of Life program is a medical history document that provides crucial personal and medical information in the case of an emergency. The document provides Paramedics and firefighteers the ncessary information, that speaks for you, in an emeregncy, when you are unable to.
Step 1: Fillout the Vial of Life Forms
  • Make and keep blank copies of the Medical Information Form for future medical updates
  • Fill out the Medical Information Form, answering all questions. This information will help Emergency Medical Services during an emergency. If a questions makes you uncomfortable just leave it blank.
Step 2: Place the forms in the plastic baggie
  • Place the Medical Information Sheet (along with your Physician's orders for Life-Sutaining Treatment (POLST) Form and your Durable Power of Attorney (if applicable), into the plastic baggie and place inside your refrigerator door.
  • You may also consider placing the following items into the baggie: copy of EKG, a recent picture of yourself, or any other items that you feel would be important.
Step 3: Place the magnet on the outside of the refrigerator door
  • Place the magnet at eye level so it can easily be seen by anyone responding to an emergency.
  • If at all possible, place the magnet on the opposite side of where the Vial of Life is located inside your refrigerator.
  • Place the cling on a window near your front door.
Vial of Life Downloads
Vial of Life Medical Information Form
California EMSAPOLST Form
Requires Adobe Reader
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