Item Detail - ID Program - Chain and Pendant
ID Program - Chain and Pendant
ID Program - Chain and Pendant  

Click here for full details on our Medical ID Program.

Before adding this item to your cart, please complete the additional form fields at the bottom of this page.
Additional information is required in order to purchase this item. Please scroll down and complete all information; you may add this item to your cart using the link at the bottom of this page after you have filled in the form below.

Form Instructions:

  • Please complete the emergency contact and engraving information form below before adding this item to your cart. Failure to complete all required fields may delay your order.

  • Located on the back of the bracelet is the preprinted emblem with MALIGNANT HYPERTHERMIA and 1-800-644-9737. Please indicate other conditions, allergies and medications needing medical attention on the BACK side of this product, using the "Engraving - Back" field below.

  • Important Legal Acknowledgement:
    The participant agrees not to wear the ID emblem until the emergency record has been carefully checked by the member for correctness and agrees to inform Maligant Hyperthermia Association of the United States (MHAUS) in writing of any error found. The participant authorizes MHAUS to relay information in response to emergency telephone calls. The participant will notify MHAUS whenever his/her medical information and/or address changes.


ID Tagholder Information:

First Name:
Last Name:
Date of Birth:


Emergency Contact Information:

Family Member 1 Name:
Family Member 1 Phone Number:
Family Member 2 Name:
Family Member 2 Phone Number:
Physician Name:
Physician Phone Number:
Physician Address:
Engraving - Front:
Engraving - Back:
Emergency Contact Comments:
 
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