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Act in Time to Heart Attack Signs

Heart Attack Survival Plan

Fill in the information below. Keep this form in a handy place. You may want to photocopy it and keep a copy at home, work, and in your wallet or purse. Share the information with emergency medical personnel and hospital staff.

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A PDF version of this document is available(filename: survplan.pdf, 49 K). Additional information about Acrobat PDF files.

Medicines you are taking:

Medicines you are allergic to:


If symptoms stop completely in less than 5 minutes, you should still call your health care provider.

Person to contact if you go to the hospital.


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