Utah Dept of Health > Bureau of EMS & Preparedness > EMS for Children

CHIRP: Enroll a Child with Special Health Care Needs (CSHCN) in the Children's Health Information Red Pack (CHIRP) program.

Utah Department of Health CHIRP

Fill out an emergency health information sheet

The CHIRP program is a free service provided by your Utah Emergency Medical Services for Children program within the Department of Health. The goal is to ensure that up-to-date information is available for emergency medical services providers if you must call 911 for your child with special healthcare needs.

Many times parents are faced with the task of informing NUMEROUS care providers about the special needs their child. This sheet is a helpful communication tool. It can be completed by you, your doctor, and/or your child’s care providers.

Keeping this sheet updated is important! You should update it when the circumstances, medications, or conditions change for your child, and you should review it at least every 6 months.

Medical conditions that qualify a child for this program are:

  • Frequent seizures
  • Tracheostomy
  • Ventilator dependency: CPAP/BIPAP
  • Congenital Heart Disease
  • Complex respiratory and cardiology needs
  • Neurologically compromised and requires suctioning for airway patency
  • Severe asthma with past admittance to ICU
  • Brittle Diabetics
  • Severe Autism

If you know your child has a medical condition that will cause you to call 911 frequently, you should enroll your child in the system.

What language would you like to use to complete the sheet?
Child's Name First Last
Child's Birthdate m/d/y
Maiden Name of the Child's Mother

 

Questions? Contact Tia Dalrymple at dalrymple@utah.gov or 801-707-3763.


Updated April 19, 2013