2. Operational Period (# ) DATE: FROM: _____________________________________ TO: ____________________________________________ 1. Incident Name TIME: FROM: _____________________________________ TO: ____________________________________________ 3. Area (Triage or Specific Treatment Area) Disposition / Time Triage Category DOB / Age (D) Discharge Name Immediate Sex (a) Admit Field Tag Medical Record (Last name, First name) Delayed Location / Time OF Procedures (M/F) Number Number Minor (S) Surgery (CT, x-ray, etc.) Expectant (T) Transfer Expired (M) Morgue
1. Incident Name 2. Operational Period (# ) DATE: FROM: _____________________________________ TO: ____________________________________________ TIME: FROM: _____________________________________ TO: ____________________________________________ 3. Area (Triage or Specific Treatment Area) Field Tag Number Medical Record Number Name (Last name, First name) Sex (M/F) DOB / Age Triage Category Immediate Delayed Minor Expectant Expired Location / Time OF Procedures (CT, x-ray, etc.) Disposition / Time (D) Discharge (a) Admit (S) Surgery (T) Transfer (M) Morgue
HICS-254-Disaster-Victim-Patient-Tracking.docx