Keeping track of your health information can be hard, but it’s important. Mercy Care provides a Personal Health Information form to help you manage your care. With this simple form, you can track your:

  • Doctors
  • Insurance information
  • Medications
  • Lab results
  • Surgeries and hospitalizations
  • Allergies
  • Blood type
  • Shot record

Download a Personal Health Information form (English).

Download a Personal Health Information form (Spanish).

4350 E. Cotton Center Blvd.,
Bldg D, Phoenix,
Arizona 85040
Member Services
7 a.m. to 6 p.m. Monday-Friday
602-263-3000,
Toll-free 1-800-624-3879
(TTY/TDD)
Toll-free: 1-866-602-1982

If you or a family member has a medical emergency, dial 911.

Information may not be current
Pending CMS Approval
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