16 Mutual Aid Agreements/Memorandum Of Understanding Facilities/Agencies Nature of Expiration Date Date Verified/POC in Agreement Agreement (if applicable) Sysco* Emergency None Food Supply XYZ Hospital* Shelter Transportation Transport service* Additional MOUs *Examples D. Sample Hospital Incident Command System Hospital Incident Command System (HICS) forms are found at HICS 203 Organization Assignment List – HICS 207 Hospital Incident Management Team Chart – HICS 254 Disaster Victim / Patient Tracking – HICS 255 Master Patient Evacuation Tracking – HICS 257 Resource Accounting Record – HICS 260 Patient Evacuation Tracking Form –
16 Mutual Aid Agreements/Memorandum Of Understanding Facilities/Agencies in Agreement Nature of Agreement Expiration Date (if applicable) Date Verified/POC Sysco* Emergency Food Supply None XYZ Hospital* Shelter Transportation service* Transport Additional MOUs *Examples D. Sample Hospital Incident Command System Hospital Incident Command System (HICS) forms are found at HICS 203 – Organization Assignment List HICS 207 – Hospital Incident Management Team Chart HICS 254 – Disaster Victim / Patient Tracking HICS 255 – Master Patient Evacuation Tracking HICS 257 – Resource Accounting Record HICS 260 – Patient Evacuation Tracking Form
Inpatient_Facility_Plan_Template_012017.docx