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Crisis and Safety Planning

First Responders Information

Below is a template of an Information for First Responders Form. You can also download a fillable PDF version to keep on your computer or phone ready for immediate use.


Person with HD Information
Name
Doctor’s Name
Doctor’s Phone #
Health Insurance Name
Policy #
Phone #
Home Address

Primary Care Partners’ Contact Information
Name
Phone #
Alternate Phone #
Address
Alternate Address

What is Huntington’s disease (HD)? 

Huntington’s disease (HD) is an inherited brain disorder that results in the progressive loss of both mental faculties and physical control. Over time, HD affects the individuals’ ability to reason, walk, and speak.  

HD typically strikes in adulthood between the ages of 35-50, but also affects people who are younger and older. HD is known as a family disease because each child of an affected parent has a 50:50 chance of inheriting the disorder. 

Common Symptoms Include: 

  • Personality changes, mood swings and depression 
  • Forgetfulness and impaired judgement 
  • Unsteady gait and involuntary movements 
  • Slurred speech and difficulty swallowing 

For more information about Huntington’s disease please:  

Visit: https://www.hdreach.org/ 

Call: 919-803-8128 

Email: info@hdreach.org 

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