Free Printable Vision, Hearing, and Communication Emergency Information Sheet
A free printable emergency information sheet for organizing glasses, hearing aids, cochlear implant context, communication preferences, assistive technology, caregiver contacts, allergies, medications, and emergency contacts.
This may be called a communication support face sheet, vision and hearing emergency sheet, accessibility handoff sheet, assistive device summary, or caregiver emergency notes page.
No signup is required to download the printable PDF.
The main emergency information sheet download stays separate.
Vision / Hearing / Communication emergency information sheet preview
Who it helps
People with vision loss, low vision, hearing loss, hearing aids, cochlear implants, speech differences, AAC tools, language needs, communication supports, or sensory needs, plus family caregivers and trusted helpers.
Why this can matter in an emergency
A caregiver, urgent care team, ER team, respite helper, school contact, travel companion, or trusted family member may need to know how the person communicates and what support tools are used.
A concise sheet may help someone find hearing aids, glasses, cochlear implant processors, chargers, AAC tools, interpreter notes, caregiver contacts, and source documents more quickly.
Vision, hearing, and communication handoff notes
These notes can explain practical supports and locations. Avoid device troubleshooting, clinical instructions, assumptions about ability, or replacing direct communication with the person.
How the person prefers to communicate and whether writing, captions, AAC, gestures, pictures, interpreter support, or a support person may help
Where glasses, hearing aids, cochlear implant processors, chargers, batteries, AAC devices, or communication cards are kept
Which caregiver, interpreter, school contact, audiologist, eye doctor, or speech-language pathologist can confirm support details
Whether lighting, noise, sensory needs, fatigue, language, mobility, memory, or caregiver support may affect a handoff
Where accessibility plans, school plans, care plans, device cards, or medical documents are kept
Where to keep it
Keep copies near communication tools, in a caregiver binder, wallet or purse, school packet, travel bag, bedside folder, go-bag, or with a trusted family member.
Tell trusted caregivers and family where the current sheet, devices, chargers, communication cards, and support documents are kept.
When to update it
Review the sheet when communication preferences, hearing or vision supports, devices, chargers, batteries, clinician contacts, medications, allergies, caregiver contacts, emergency contacts, or document locations change.
It may also be worth reviewing after a device change, clinic visit, school plan update, travel plan, hospital discharge, or new caregiver handoff.
Privacy and safety notes
Communication and disability information can be personal. Share only what is useful for emergency organization and respectful handoff.
This page is for organization and emergency preparedness only. It is not medical advice and does not replace 911, EMS, clinicians, interpreters, accessibility rights, device instructions, medical records, medication labels, school plans, care plans, patient portals, or direct communication with the person.
Printable sheet versus digital emergency profile
A digital YourEMR profile may help when communication preferences, device locations, caregiver contacts, medications, allergies, or document locations change. It can be updated, printed again, or shared through an emergency QR link.
Helpful terms families may hear
Low vision: Vision loss context that may affect reading, navigation, or written communication.
Hearing aid: A device that can make some sounds louder and may need batteries, chargers, or location notes.
Cochlear implant: A device with external and implanted parts; the sheet can note external processor context and contacts.
AAC: Augmentative and alternative communication tools such as devices, apps, pictures, gestures, or boards.
Interpreter needs: Language or communication support notes that may help another person arrange appropriate communication support.
Caregiver handoff: Short notes that help another trusted person find communication supports, contacts, and current documents.
Vision / Hearing / Communication details to record
Use short, respectful entries from the person's own preferences, caregiver records, device labels, clinician notes, school documents, or support plans.
Preferred communication method, primary language, interpreter needs, hearing or vision notes, speech or AAC context, and sensory support notes
Glasses, contacts, hearing aids, cochlear implant processor, AAC device, communication card, charger, battery, app, or assistive technology locations
Audiologist, eye doctor, speech-language pathologist, primary doctor, school support contact, interpreter contact, or caregiver contact if applicable
Medications, allergies, emergency contacts, decision-maker contact if applicable, and document locations
What helps the person understand information, without reducing the person to a diagnosis or assuming they cannot participate
Related YourEMR resources
Use these related YourEMR pages when they fit the person's situation.
Helpful vision, hearing, communication, and preparedness resources
These outside resources are for general education only. Always follow the person's clinicians, device instructions, interpreters, support plans, 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.
