Chronic Condition Management Plan for Travelers
Traveler Information
Name
Date of Birth
Contact Information
Emergency Contact Name & Relationship
Emergency Contact Number
Health Insurance Details
Chronic Condition Details
Condition(s)
Current Status / Last Assessment
Treating Physician Name & Contact
Medications
Medication Name
Dosage & Frequency
Special Instructions
Allergies and Adverse Reactions
Travel Considerations
Required Medical Equipment/Supplies
Temperature/Moisture/Light Sensitivities
Vaccinations / Prophylaxis Needed
Planned Destinations
Action Plan
Signs of Worsening Condition
Immediate Steps if Symptoms Occur
When to Seek Emergency Care
Useful Phrases (in local language)
Additional Notes