Contagion Health Get Up and Move: Social Gaming for Better Health

Build it

$*&^)@
creek

Thursday, July 22, 2010

“Barter healthy
actions”


Surplus of online support +
scarcity of ofﬂine actions =
'bursts' of microﬁtness.


Personal Medical History & Medication Form

Last Name _____________________________________________ First Name ___________________________________________ DOB _____________
Marital Status ____________________________________ Religion _______________________________________ ! Male ! Female
Address ___________________________________________________________________________ State __________________ Zip Code _______________
Phone (Home) ___________________________________ (Work) ___________________ ________ (Cell) ___________________________________
_
ALLERGIES to Medications: ! YES ! NO If Yes, list allergies _________________________________________________________________________________
ALLERGIES to Foods, Man-Made Materials, etc.: ! YES ! NO If Yes, list allergies ________________________________________________
Insurance Co. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Policy No. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
____________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Emergency Contact: Name ___________________________________________________________Relationship __________________________________
_
Who Do You Grant Permission to Speak on Your Behalf? (If Different Than Emergency Contact)
Emergency Contact: Name ___________________________________________________________Relationship __________________________________
_
Physicians (Health Care Providers(s)):
Name __________________________________________________Specialty _________________________________Phone ____________________________
Name __________________________________________________Specialty _________________________________Phone ____________________________


Playdom? Zynga?


Contagion Health Get Up and Move: Social Gaming for Better Health

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