Free Printable Dialysis Center and Care Team Emergency Sheet
Use this dialysis emergency sheet to record dialysis center contact, usual schedule, nephrologist contact, access type or location as recorded information, transportation backup, medication-list location, care-plan location, caregiver contacts, and emergency contacts.
This may be called a dialysis face sheet, kidney failure emergency information sheet, hemodialysis handoff sheet, peritoneal dialysis summary, or caregiver emergency notes page.
No signup is required to download the printable PDF.
The main emergency information sheet download stays separate.
Dialysis emergency information sheet preview
Who it helps
People receiving in-center hemodialysis, home hemodialysis, or peritoneal dialysis, plus family caregivers, transportation helpers, home health aides, travel companions, long-distance family, and trusted contacts.
Why this can matter in an emergency
A caregiver, family member, transportation helper, urgent care team, ER team, dialysis center, or travel companion may need to find dialysis contacts and basic context quickly.
A concise sheet may help another person locate the dialysis center, nephrology contact, current medication list, allergy list, caregiver contacts, and fuller care-plan documents.
Dialysis handoff notes
These notes can help someone find contacts and documents, not to explain treatment.
Who knows the current dialysis schedule and whether a dialysis center or home dialysis team should be contacted
Where the access card, appointment information, care-plan paperwork, or treatment documents are kept
Which caregiver or family member handles transportation or schedule coordination
Where medication lists, allergy lists, renal diet notes, or fluid notes are kept if the person chooses to share them
Whether communication, mobility, hearing, vision, language, or caregiver support needs may affect a handoff
Where to keep it
Keep copies with the dialysis bag, home dialysis binder, caregiver binder, wallet or purse, travel packet, refrigerator folder, or trusted family member.
Tell trusted caregivers and family where the current sheet and official dialysis paperwork are kept. A visible copy should include only the information the person is comfortable sharing.
When to update it
Review the sheet when dialysis type, schedule, center, nephrologist, home dialysis contact, access information, medications, allergies, pharmacy, transportation contacts, caregiver contacts, or emergency contacts change.
It may also be worth reviewing after a hospital discharge, access change, medication change, dialysis center change, travel plan, or new caregiver handoff.
Privacy and safety notes
Dialysis information can be sensitive. Share only what is useful for emergency organization and caregiver handoff.
This page is for organization and emergency preparedness only. It is not medical advice and does not replace 911, EMS, clinicians, dialysis center instructions, access-care instructions, treatment plans, medical records, medication labels, diet or fluid guidance, discharge instructions, care plans, or patient portals. Do not use it to change dialysis, medications, fluid intake, diet, or access care.
Printable sheet versus digital emergency profile
A digital YourEMR profile may help when dialysis center contacts, nephrologist contacts, schedules, medications, allergies, transportation notes, or caregiver contacts change. It can be updated, printed again, or shared through an emergency QR link.
Helpful terms families may hear
Hemodialysis: A dialysis treatment that filters blood through a dialysis machine; the sheet can note the schedule and center.
Peritoneal dialysis: A home dialysis option that uses the lining of the abdomen; the sheet can note contacts and where the plan is kept.
Dialysis access: A fistula, graft, catheter, or other access described only as factual context from the care team.
Nephrologist: A kidney specialist contact.
Renal diet notes: Caregiver-provided context or document location, not diet instructions from the sheet.
Caregiver handoff: Short notes that help another trusted person find dialysis contacts, schedule information, and current documents.
Dialysis details to record
Helpful details may come from the person's dialysis paperwork, medication list, care plan, appointment card, transportation notes, or caregiver records.
Dialysis type, such as in-center hemodialysis, home hemodialysis, or peritoneal dialysis, written at a high level
Usual dialysis schedule, dialysis center, nephrologist, home dialysis contact, and transportation contact if applicable
Access type or location as emergency context if the person chooses to include it, without access-care instructions
Medications, allergies, pharmacy, emergency contacts, caregiver contacts, and decision-maker contact if applicable
Diet or fluid notes only as caregiver-provided context, plus where the official care plan and dialysis instructions are kept
Related YourEMR resources
Use these related YourEMR pages when they fit the person's situation.
blood thinner sheet - Use when medication details and prescriber contacts need extra focus.
Helpful dialysis and preparedness resources
These outside resources are for general education only. Always follow the person's nephrologist, dialysis center, home dialysis team, treatment plan, medication labels, and care plan.
These free sheets are informational organization tools only. They are not medical records, diagnosis tools, treatment plans, medical advice, or legal advice, and they do not replace 911, EMS, clinicians, medical records, medication labels, device manuals, care plans, patient portals, or professional guidance.
