HICS254 - DISASTER VICTIM / PATIENT TRACKING
HICS - Hospital Incident Command System

   1. Incident Name  

      Page  Of         Express Sender  {var MsgSender}

        

                                                                    
    2. Operational Period   (#): 

          Date From      To  

           Time From         To  

 3. Area (Triage or Specific Treatment Area)   

Field Tag Number Medical Record # Name
Sex DOB - Age Triage Category Location of Procedures
Procedure Time
Disposition  Disposition Time

 4. Prepared By:       Date   Time:      Facility:                        Vers 9.0