Child’s name:
Medical condition(s):
Primary care physician:
Phone:
Emergency phone numbers:
Closest emergency room: ______________________________________________
Children’s Healthcare of Atlanta Emergency department: 404-250-KIDS
Ambulance: __________________________________________________________
Georgia Poison Center: 404-616-9000 or 800-222-1222
Craniofacial Team
The Children’s Center for Craniofacial Disorders: 404-785-2239 or 800-848-9049
Craniofacial surgeon: _________________________________________________
Craniofacial nurse: ___________________________________________________
Speech pathologist: ___________________________________________________
Audiologist: __________________________________________________________
Occupational therapist: _______________________________________________
Nutritionist: __________________________________________________________
Lactation consultant: __________________________________________________
Pediatric dentist: ______________________________________________________
Orthodontist: _________________________________________________________
Geneticist: ____________________________________________________________
Psychologist: ___________________________________________________________
Neuropsychologist: _____________________________________________________
Social worker: _______________________________________________________
Insurance company: __________________________________________________
Medicaid number: _____________________________________________________
In the Hospital
Chaplain: ____________________________________________________________
Child life specialist: ____________________________________________________
School teacher: ________________________________________________________
Primary nurse (inpatient): _______________________________________________
Other Numbers
Pharmacy: _______________________________________________________________
Closest relative or neighbor: _____________________________________________