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Seniors & First Responders
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Senior Information
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Emergency Contact Information
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Medical / Health Information
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Please provide a brief description of any medical or health issues the senior may have. This information can be used in cases of emergencies where medical services may need to know the medical history of a patient.
Doctor Name
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Last Name
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Additional Comments
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I authorize the Rosenberg Police Department to release any medical or health related information provided to emergency personnel during emergencies.
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