Stamped Out

Medical Warning Tag Order Form

Thank you for ordering a Medical Warning Tag from Stamped Out.  In order for us to know what you want on your tag, you will need to fill out this handy form.

Name:  
E-mail:  
Order Number:  

 

Instructions
The medical Warning tags can fit 5 lines of text with 17 characters per line. All spaces and punctuation count as characters. If you want to leave a line blank, type BLANK LINE into the box so that we know you want it left blank. The characters we have available are:

Character What it is
A-Z Alphabet
0-9 Numbers
' apostrophe
- hyphen
½ 1/2 symbol -  for apartments
℅ 'In Care Of' symbol - for employee's addresses
& Ampersand
, Comma
. Period
c Small c - helpful for names like McARDLE

 

The tag will be printed exactly as you type it. We recommend that you double and triple check your spelling before submitting the form. 

According to Army Regulations the tag layout follows this format, but you can choose anything you want:
LINE 1 (Individual Identification) Enter the patient's name (Last, First, Middle) or last name and initals.  Enter the sponsor's SSN following the middle initial. When space is insufficient for name and SNN on this line, use line two for continuation.
LINE 2 OR NEXT UNUSED LINE (Drug, Serum, or Other Allergy) Enter 'ALLERGY' on the next unused line beginning in block number one, and on the next unused line (beginning in block number one), the drug, serum, or other agent, for example, 'PENICILLIN'
LINE 3 OR NEXT UNUSED LINE (Specific Conditions or Potential Problems) Enter the name of the condition or potential problem on the next unused line beginning in block number one, for example, CONTACT LENSES, DIABETES MELLITUS.
LINE 4 OR NEXT UNUSED LINE (Specific Drug Therapy) If a specific drug has been prescribed, enter on this line: "I take (name of drug), for example, INSULIN." In addition, if individual has more than one condition or is taking more than one medication, list those on the next unused line.

This form does not recognize spaces entered before any characters.  IF YOU WANT SPACES BEFORE A CHARACTER YOU MUST USE THE '*' TO DENOTE A SPACE!  So in other words, if you want your religious preference in the 15th spot, please use this format:
**************P
so we don't put it in the 1st spot.

Line Number Text
Line 1
Line 2
Line 3
Line 4
Line 5

Ball chain options
The Medical Warning Tag comes with your choice of ball chain length and style.  If you plan on putting your tag on your keychain you may select the 'no chain' option.
Chain Options

If you have any additional information please enter it below.

    



If you are ordering more than one tag, you will need to fill this form out for each tag. Once you submit this form you will be taken to the 'Form Confirmation' page. On the bottom there is a link that will return you to the form. Click on it and enter the information for the second tag.

Having questions or difficulties with this order page?
Please contact questions@stampedout.net