FOSTER CHILD

Emergency Medical Profile

Joseph (Case #F-99482)

Printed on product as “Joey”

DOB:12 / 10 / 2025

Primary Medical Condition No Chronic Medical Conditions (Active Foster Placement Record).
Life-Saving Alerts — Critical 🛑 FOSTER CHILD: STRICT CUSTODY PROTOCOL. ONLY RELEASE TO CONTACTS BELOW.
Medical Devices & Implants None

Vital Medical Alerts

Communication & Mobility Needs Non-verbal (Infant). Completely dependent on caregiver for all transportation and care.
Special Instructions for First Responders This child is in active foster care. In an emergency, do NOT release this infant to any biological family members or unauthorized individuals. Photo ID verification is strictly required for custody release. Contact the DCS county emergency caseworker immediately.

Emergency Contacts

Primary Emergency Contact

Sarah Jenkins

Foster Mother

(574) 297-6703Tap to call
Backup Emergency Contact

DCS County Emergency Line

Caseworker Assignment

(555) 014-9900Tap to call
Additional Emergency Contact

Mark Jenkins

Foster Father

(555) 019-2835Tap to call

Patient Demographics

Home Address 21224 North Market Street (foster parents)
Delphi, IN 46923

Clinical & Insurance Details

Primary Care Physician Northside Pediatrics
(555) 012-4400Tap to call
Insurance Provider & Policy # (optional) Indiana Medicaid / Policy: #IN-FOST-8821A

Legal Authorization

I authorize emergency medical personnel and first responders to access the information on this profile for the purpose of providing emergency medical care to the individual named above. This information is accurate to the best of my knowledge as of the date listed below.

Form Completed By Sarah Jenkins (Foster Mother)
Date Completed 06 / 16 / 2026

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