Medical Alert Response Plan is one of the many benefits of having a countywide enhanced 9-1-1, and Computer Aided Dispatch system, is the ability to enter into the system an emergency response plan for any location in the county.
As a 9-1-1 call is received from a specific location, the dispatcher is automatically made aware of the address information, along with any special response information. This information will expedite the response of Police, Fire, or EMS personnel, while providing life-saving pre-arrival information.
To better serve those individuals with special medical needs, Lapeer County Central Dispatch can enter into the computer aided dispatch system, any information pertaining to special medical concerns, along with other emergency contact information. Click on the link below and a form will appear that can be printed, completed and then returned to Lapeer County Central Dispatch, or you can fill out the Online form, and submit your information electronically.
This information will then be entered into the Computer Aided Dispatch system. This confidential information will become available for the dispatcher when a 9-1-1 call is made. Therefore, if the caller is unable to communicate with the dispatcher, the emergency alert information will provide valuable insight to expedite sending the appropriate public safety response.
**Once a year a representative from Lapeer County 9-1-1 will call the listed contact/concerned person and verify that the information we have on record is up to date.

Click here to download and mail us the Medical Alert Form.

Please fill out all information regarding the concerned individual:

First Name
Last Name
Middle Initial
Date of Birth
Sex	Male Female
Height
Weight

Please print all information regarding the concerned address:

Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone

Do you require the use of a TDD? (Telecommunications Device for the Deaf)

Yes No

Please place a check in the space provided for all conditions which apply.

Use a cane/wheelchair/walker		Asthma                  	High Blood Pressure
Blind/Difficulty Seeing		Using Oxygen         	Deaf/Hard of Hearing
Psychiatric/Emotional Problems	Diabetic                  	Seizures
Heart Condition			Pets in Residence	Difficulty Speaking

Allergic to any medications (please list)

Other:

In case of an emergency, please notify:

First Name
Last Name
Middle Initial
Date of Birth
Sex	Male Female

Emergency Contact Address

Name & Relation
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone

I hereby authorize entrance to my residence by any law enforcement and/or fire and rescue personnel if it is believed that I am in need of assistance and am incapacitated.
By typing your name here, this acts as a legal copy of your personal signature:

Name

Today's Date

-- mm/dd/yy

***A separate form should be completed for each individual member of the residence to whom conditions apply (i.e., one for husband, one for wife). This information will be kept on file at Lapeer County Central Dispatch and will NOT be released to anyone without your consent. Your signature certifies that the information is accurate and authorizes entry into your residence in case of an emergency.