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Person At Risk - Bio Form
Last Name *
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First Name *
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Date of Birth *
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DD
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Race
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Sex
Height *
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Weight *
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Hair Color *
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Eye Color *
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Scars or Birth Marks
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Wears Glasses
Does the person prefer any Nicknames, If so please provide
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Home Address *
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Persons Phone Number *
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School Attended if any
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Close friend to call if needed
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Persons email address
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Persons Primary Emergency Contact *
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Persons Secondary Emergency Contact *
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Persons Caregiver Contact *
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What is the best means of communication with the person so that we can meet their needs?
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What Means are best at comforting the person?
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Are there any behavior issues? *
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If there are behavoir issues what response have you found that works best to calm the person?
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Are there dislikes or sensitivities?
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Are there any fears?
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If there are fears how does the person react and how have you found works best to handle the situation?
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Please list any medications
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Please list any allegies
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Are there any hazards near the home?
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Does the person have seizures?
If the person has seizures what do they look like?
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Is there any other important information that will help identify the risk or assist personnel to care for and maintain the safety of this person?
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Do you give permission to the Town of Hopkinton Police Department to retain and distribute this information to first response personnel for the sole purpose of identification and assistance to the person at Risk *
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