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Medi-Card (QR Coded)

R399,00

SKU: scqrcard Categories: , Tag:

Description

Introducing the QR Medi-Card™

MEDICAL ALERT ID WALLET CARD
  • In emergencies, every second counts! Our QR Medi-Card is the secure, innovative way to share critical medical information with just a scan.
  • R399 – Includes QR Card plus 12 months FREE online data hosting. After that, R50 every 4 months or R100 per year — cancel anytime. (Both options set up as recurring payments via PayFast for ease and reliability.)
  • Free, secure web hosting
  • Your Choice – Custom selection of On-Line data (POPI Act)*
  • Password protection for your privacy (Optional)
  • Free online data updates (E.g. Medicine, Conditions)
Be prepared and protected.
Front and Back or Card
Dr Ethan
Scan me to test
ICE Medi-Card™ (QR Coded) Application Form

Form: ICE-QRCARD

ICE Medi-Card™ (QR Coded) Application Form

Section 1: Basic Identification (Front of Card)

Please provide only the most critical information that a first responder would need in an emergency. This includes details to identify you, understand your key medical needs, and contact your emergency contact quickly. Leave detailed information for later sections.
Personal Information of Applicant:
Full Name (e.g., as it appears on your ID):
Drag & Drop Files, Choose Files to Upload
Please upload a recent photo of yourself. In case of an emergency, this image may help first responders identify you quickly and accurately.
Delivery Address:
Kindly select from the available courier options listed below if necessary.
Please choose the appropriate option.
Kindly provide contact number to reach you through WhatsApp.
FRONT OF CARD: Please provide your South African ID number.
FRONT OF CARD: Please provide your date of birth .
FRONT OF CARD: Please provide the name and number of your medical aid. (E.g. Polmed - 123456)
Include your physician’s full name, clinic name, office address, and direct phone number. If they have an after-hours or emergency line, please prioritize those details.
Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.
Please upload clear images of both the front and back of your medical aid card. This will assist emergency personnel in verifying your coverage and accessing critical medical information.
Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.
Please upload clear images of both the front and back of your driver's license card. (Optional)
Kindly provide the most critical medical conditions. (E.g. Diabetes, Severe Allergies (Bee Sting), Epilepsy)
Kindly list your most essential medications (for example, insulin, EpiPen, blood thinners, nitroglycerin, or valproate). You may also share your most recent prescription by sending it via WhatsApp, or alternatively, upload it directly through the Additional Documents File Upload field provided.
Provide a complete list of Chronic Conditions
Please indicate if you have an active Do Not Resuscitate (DNR) directive. This information is vital to ensure emergency personnel respect your medical wishes. If you answer 'Yes,' a file upload field will appear for your official documentation.
Please indicate your organ donor status. This helps ensure that your donation wishes are known and respected. If you answer 'Yes,' please upload your official donor card or registration in the field provided.
FRONT OF CARD: Please provide the name and number of the primary emergency contact.
FRONT OF CARD: Please provide the name and number of the secondary emergency contact.

Section 2: Comprehensive Information linked to QR Code

This section ensures that first responders and healthcare professionals can access all the critical details needed to assist you in an emergency. Please take your time to fill in each field accurately and completely. You can update your information anytime to keep it current. **What to include:** -(1) A full record of your medical history, allergies, and medications. -(2) Multiple emergency contacts for added security. -(3) Details that could help responders provide the best care (e.g., conditions, treatment plans, or doctor information). **Note:** This information will only be accessible by scanning the QR code on your Medi-Card and is protected for your privacy and security. (Protection Optional)
Why are we asking this? Providing your gender helps first responders and healthcare professionals offer the most accurate and appropriate care. If you’re unsure or prefer not to share this information, you can select “Prefer Not to Say.”
Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.
Please upload clear images of both the front and back of your national ID card. This will assist emergency personnel in verifying your information.
Provide a complete list of Chronic Conditions
Please Include dates
Current Medical Treatments/Plans (e.g., Physical Therapy, Dialysis):
Comprehensive Allergy List (Include severity, e.g., mild, severe):
Full Medication List (Include dosages and frequency):
Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.
Please upload a clear copy of your most recent prescription. This will assist emergency personnel in understanding your current medical needs, ensuring accurate treatment, and avoiding any contraindicated medications.
Recent Changes to Medications (Within the past 6 months):
Smoking Status:
Alcohol Consumption:
Dietary Restrictions (e.g., Vegan, Gluten-Free):
Optional Notes for Responders (e.g., "Please check blood sugar levels before administering insulin"):
Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.
You may upload any additional documents or images that could assist emergency personnel in providing fast and accurate care. Examples include allergy summaries, vaccination records, chronic condition details, hospital discharge notes, DNR instructions, living will, or emergency contact sheets.
Create a Unique Identifier (e.g., PIN for account access):
In compliance with the POPIA, Stainless Charm (Pty) Ltd. (Trading As Medical Alert SA, PawPortal, and Mediq‑R) offers optional password protection for your profile; however, if you enable this feature, paramedics or first responders may be unable to access your medical information in an emergency, which could delay care, and by choosing password protection you accept full responsibility for any consequences of restricted access, acknowledging that Stainless Charm cannot be held liable for delays, harm, or adverse outcomes resulting from password‑protected profiles, and for fastest emergency response we recommend leaving your profile unprotected.
Consent to Store and Share Data via QR Code:
Why are we asking this? By providing your consent, you allow us to securely store your medical information and make it accessible through the QR code on your Medi-Card. This ensures first responders and healthcare professionals can access critical details in an emergency, potentially saving your life. We are committed to protecting your privacy, and your data will only be used for this purpose.
Acceptance of Terms
**Acceptance of Terms** By using the QR Medi-Card service, you agree to the terms outlined in our privacy policy and understand the risks associated with digital data storage and sharing.
Review Submitted Information (Confirmation step before submission):
**Declaration of Accuracy** By confirming, you acknowledge that the information provided is accurate and up-to-date to the best of your knowledge. This ensures that the details linked to your QR Medi-Card are reliable and can assist first responders in providing appropriate care during emergencies. **Why are we asking this?** This step gives you an opportunity to double-check all the details you've entered before finalizing your submission. Ensuring accuracy is vital, as this information will be used in emergencies and linked to your QR code. Taking a moment to review helps avoid errors and ensures responders have the correct and complete details when they need it most.

Costs – Simple, Affordable, Powerful (Powered Via PayFast)

The Medical Alert QR Code setup is a once-off fee of R399, which includes the creation of your personalized medical profile, QR code generation, a wallet-sized QR card, and one year of free web hosting. After the first year, you can continue the service with either a cost-effective R100/year plan or a convenient Quarterly Plan at R50 every 4 months, both set up as recurring payments via PayFast for ease and reliability. Your emergency information is always accessible via QR code, and you can update your online data at any time. The service is completely flexible, with no contract required, and you may cancel at any time.
After your first 12 months of free web hosting, you’ll have access to flexible payment plans with automatic renewal via PayFast. No contracts, no pressure — cancel anytime.

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