TIMMONS, BENJAMIN SAMPLE

Emergency Medical Profile

Benjamin Lee Timmons

Printed on product as “Ben”

DOB:04/12/2011

Photo of Patient Photo of Patient
Primary Medical Condition Refractory Epilepsy (Grand Mal / Tonic-Clonic Seizures).
Life-Saving Alerts — Critical EPILEPSY / TONIC-CLONIC SEIZURES. VNS IMPLANTED. NO MRI.
Medical Devices & Implants VNS IMPLANTED. NO MRI.

Vital Medical Alerts

Communication & Mobility Needs Post-ictal phase (following a seizure) causes severe confusion, temporary loss of speech, and extreme fatigue.
Special Instructions for First Responders Protect head during seizures. Do not restrain. Time the duration. Swipe left chest with a VNS magnet if seizure lasts over 2 minutes. Administer rescue nasal spray if seizure exceeds 5 minutes.

Emergency Contacts

Primary Emergency Contact

Karen Timmons

Mother

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

Frank Timmons

Grandfather

(555) 456-7891Tap to call
Additional Emergency Contact

James Timmons

Father

(555) 563-3214Tap to call

Patient Demographics

Home Address 742 Evergreen Terrace
Delphi, IN 46923

Medications & Dosage

  • Levetiracetam (Keppra)

    | 1000mg — | 2x Daily (Morning/Night)

  • Lamotrigine (Lamictal) |

    200mg — | 2x Daily (Morning/Night)

  • (Rescue): Nayzilam (Midazolam) Nasal Spray

    5mg — As Needed (Seizures >5 mins)

Clinical & Insurance Details

Primary Care Physician : Dr. Keith Larson
(555) 012-7744Tap to call
Insurance Provider & Policy # (optional) Anthem Blue Cross / Policy: #ANT-9928341-01

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 Karen Timmons, mother
Date Completed 06 / 15 / 2026

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