This form creates a SQR image based on your input that can be scanned by any generic SQR/barcode app. You can save it to your phone by taking a photo; this will let you communicate any medical information you wish to release in such a way.

This app is meant to be a demo product and any information input here is stored as a image file on the server; this file gets overridden each time info is posted. Please bear that in mind in using. AIdvocate assumes no liability in its use and is providing it here for demonstrative purposes.

Input upto 255 chars in each field and use commas to separate the words properly. Do not use quotes as it may intefere with the reading.

Example: typing in 'Asthma, high blood pressure, arthritis' in the Medical Conditions field generates the following text block {'sqrconditions':'Asthma,high blood pressure,arthritis'}.

Use it as a screen saver or print it out as label to have on your phone or emergency info card. Print out one for your children or any one who would be a high risk case in an emergency.