Patient ID Card
Patient ID Card
Get Yours Today!

We at US HAEA have wallet-sized ID cards available for HAE patients. The card contains links to online, authoritative HAE information. Inside the folded wallet card, you can enter your personal and medical information.

You may wish to coordinate with your physician on what information to include.

Carry your ID card with you, and be sure to get one for each of your HAE-affected family members.

Simply fill out the online form for your card, and for each additional card request.

Please remember you can also always contact your Patient Advocates Team member with any HAE concerns you may have.


Complete the form below to get your ID card.

Patient Name: 
 
Address: 
 
 
City: 
State:    Zip Code: 
 
Telephone Number: 
E-mail address: 
 
Emergency Contact Name: 
Emergency Contact Telephone: 
 
Treating Physician's Name: 
Treating Physician's Telephone: 
Treating Physician's
After-Hours Telephone: 
 
Pharmacy Name: 
 
Pharmacy Address: 
 
 
City: 
State:    Zip Code: 
 
 
Current Treatment for HAE: