Below is a template of an Information for First Responders Form. You can also download a fillable PDF version to keep on your computer or phone ready for immediate use.
| Person with HD Information | |
|---|---|
| Name | |
| Doctor’s Name | |
| Doctor’s Phone # | |
| Health Insurance Name | |
| Policy # | |
| Phone # | |
| Home Address |
| Primary Care Partners’ Contact Information | |
|---|---|
| Name | |
| Phone # | |
| Alternate Phone # | |
| Address | |
| Alternate Address |
What is Huntington’s disease (HD)?
Huntington’s disease (HD) is an inherited brain disorder that results in the progressive loss of both mental faculties and physical control. Over time, HD affects the individuals’ ability to reason, walk, and speak.
HD typically strikes in adulthood between the ages of 35-50, but also affects people who are younger and older. HD is known as a family disease because each child of an affected parent has a 50:50 chance of inheriting the disorder.
Common Symptoms Include:
- Personality changes, mood swings and depression
- Forgetfulness and impaired judgement
- Unsteady gait and involuntary movements
- Slurred speech and difficulty swallowing
For more information about Huntington’s disease please:
Visit: https://www.hdreach.org/
Call: 919-803-8128
Email: info@hdreach.org
