Vial of Life

Patient Information for use by EMS and Staff at a Receiving Medical Facility

The Vial of Life helps to save lives and is often critical for emergency personnel that arrive on the scene and find a patient who cannot communicate for whatever reason. This information is to be kept secure with the patient or with other patient records under the protection of the Health Insurance Portability and Accountability Act (HIPAA). The form is intended to provide medical personnel with needed information. It is up to the individual to determine what information will or will not be provided.

Please make a copy for EMS to take and place on your refrigerator. The last page of the form below has a set of decals to print off that can be posted.

Contact us at 919.380.6909 or via email at