Creation of Standard Medical Information Form

1. Law
2. Tennessee Code
3. Motor and Other Vehicles
4. Highway Safety
5. Yellow Dot Motor Vehicle Medical Information Program
6. Creation of Standard Medical Information Form

1. The department of transportation is authorized to create a standard medical information form providing space for each participant to supply, at a minimum, the following information:
   1. Name;
   2. Photograph;
   3. Emergency contact information of no more than two (2) persons;
   4. Medical information, including medical conditions, recent surgeries, allergies, and medications being taken;
   5. Hospital preference;
   6. No more than two (2) physicians' contact information; and
   7. The date on which the participant completed the form.
2. The medical information form shall include a statement that the yellow dot program acts as a facilitator only, and that all information supplied on the medical information form is the sole responsibility of the participant.
3. The medical information form shall also include statements that the participant supplies the medical information voluntarily, and that the participant authorizes the disclosure to, and use of, the medical information by emergency medical responders and other responders for the purposes described in § 55-20-308.

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