HICS 206 – STAFF MEDICAL PLAN
1. INCIDENT NAME 206 incident
2. DATE PREPARED 2011-11-01
3. TIME PREPARED 0749L
4. OPERATIONAL PERIOD DATE/TIME til the twelfth of never
5. TREATMENT OF INJURED / STAFF
Location of Staff Treatment Area
Contact Information
Treatment Area Team Leader
Contact Information
Special Instructions be kind and gentle
6. RESOURCES ON HAND
STAFF
MD/DO:
PA/NP:
RN/LPN:
Technicians/CN:
Ancilliary/Other:
MEDICAL TRANSPORTATION
Litters:
Portable:
Transport:
Wheelchairs:
Other:
MEDICATION
SUPPLIES
7. ALTERNATE CARE SITE(S)
NAME:
ADDRESS:
PHONE:
SPEC CARE:
NAME:
ADDRESS:
PHONE:
SPEC CARE:
NAME:
ADDRESS:
PHONE:
SPEC CARE:
NAME:
ADDRESS:
PHONE:
SPEC CARE:
8. PREPARED BY (SUPPORT BRANCH DIRECTOR): dave
9. FACILITY NAME whitfield