Medical Plan       ICS 206  
{var FormTitle}
 1. Incident Name:  
  2. Operational Period:
Date From: Date To:
Time From: Time To:
  3. Medical Aid Stations
Name Location Contact
Number(s)/Frequency
Paramedics
{var Med_Line1}
{var Med_Line2}
{var Med_Line3}
{var Med_Line4}
{var Med_Line5}
  4. Transportation
Ambulance Services Address and Phone Contact
Number(s)/Frequency
Level of Service
{var Amb_Line1}
{var Amb_Line2} 
{var Amb_Line3}
{var Amb_Line4}
  5. Hospitals   
Hospital Name Address,
Latitude & Longitude
if Helipad
Contact
Number(s)/
Frequency

Travel Time

Trauma
Center
 Burn Center Helipad
Air Ground
{var HosTrama1}
{var burn1}
{var heli1}
{var HosTrama2}
{var burn2}
{var heli2}
{var HosTrama3}
{var burn3}
{var heli3}
{var HosTrama4}
{var burn4}
{var heli4}
{var HosTrama5}
{var burn5}
{var heli5}

 6. Medical Emergency Procedures   (Be brief)
{var Procedures}

 7. Prepared by (MUL):      

  8. Approved by (Safety Officer):      Date/Time       IAP Page:

 ICS 206  Vers 14.2