Vial of Life Program Components
Vial of Life program includes a large medicine vial container and a one-page form. The form asks each person to complete sections about their medical history, allergies, medications and emergency contacts.
Additional copies of medical documents such as DNR (do not resuscitate) orders may also be added to the vial.
Vial of Life Form
Download the Vial of Life Form (PDF).
Window Decal
Download the Vial of Life Window Decal (PDF).
Where to Get Your "Vial of Life" Kit
Vial of Life kits are free and available at any of the following locations:
- Print or type your medical information on Vial of Life Form (PDF).
- Place the form into the Vial of Life container--either a bottle or baggie.

- Put the Vial of Life container either IN (if a bottle) or ON (if a baggie) your fridge's freezer door.

- Apply the Vial of Life decal to your front window.
Notes About Vial of Life
- Do not place any medications in the Vial of Life container.
- Your Vial of Life container should only contain medical information; it can be used in addition to a Physician's Order for Life Sustaining Treatment (POLST).
- The Vial of Life program is a free life safety preparedness program coordinated by Cosumnes Fire Department.