List existing mutual aid agreements (MAAs) and/or memorandums of understanding (MOUs). MAAs/MOUs are stored <Insert location>. Table : Mutual Aid Agreements/Memorandum of Understanding Facilities/Agencies Nature of Expiration Date Date Verified/Point in Agreement Agreement (if applicable) of Contact Hospital* Transfer* None* Supplier* Medications* Transportation 911* service* Supplier* Oxygen* Additional MAAs/MOUs * Examples Attachment C: Alternate Care Site Evacuation Routes and Center Floor Plans <Insert evacuation routes, floor plans, maps, and written directions to evacuation sites> Attachment D: Sample Hospital Incident Command System Forms Hospital Incident Command System (HICS) forms can be provided by the Emergency Planner. 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 – Attachment E: Affiliated Facilities Specific Information This attachment should include the following location specific information: Table 2: Exercises Conducted
List existing mutual aid agreements (MAAs) and/or memorandums of understanding (MOUs). MAAs/MOUs are stored <Insert location>. Table : Mutual Aid Agreements/Memorandum of Understanding Facilities/Agencies in Agreement Nature of Agreement Expiration Date (if applicable) Date Verified/Point of Contact Hospital* Transfer* None* Supplier* Medications* Transportation service* 911* Supplier* Oxygen* Additional MAAs/MOUs * Examples Attachment C: Alternate Care Site Evacuation Routes and Center Floor Plans <Insert evacuation routes, floor plans, maps, and written directions to evacuation sites> Attachment D: Sample Hospital Incident Command System Forms Hospital Incident Command System (HICS) forms can be provided by the Emergency Planner. 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 Attachment E: Affiliated Facilities Specific Information This attachment should include the following location specific information: Table 2: Exercises Conducted
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