Form: HICS254_Initial.html,HICS254_Viewer.html To: Subject: HICS254-- Msg: 1. INCIDENT NAME: PAGE [] OF [] Express Sender: 2. OPERATIONAL PERIOD: #:[] Date From: Time From: Date To: Time To: 3. AREA (Triage or Specific Treatment Area) --------------------------------------------------------------------- Field Tag #: Medical Record #: Name: Sex: DOB-Age: Triage Category: Procedures Location: Procedures Time: Disposition: Disposition Time: Field Tag #: Medical Record #: Name: Sex: DOB-Age: Triage Category: Procedures Location: Procedures Time: Disposition: Disposition Time: Field Tag #: Medical Record #: Name: Sex: DOB-Age: Triage Category: Procedures Location: Procedures Time: Disposition: Disposition Time: Field Tag #: Medical Record #: Name: Sex: DOB-Age: Triage Category: Procedures Location: Procedures Time: Disposition: Disposition Time: Field Tag #: Medical Record #: Name: Sex: DOB-Age: Triage Category: Procedures Location: Procedures Time: Disposition: Disposition Time: Field Tag #: Medical Record #: Name: Sex: DOB-Age: Triage Category: Procedures Location: Procedures Time: Disposition: Disposition Time: Field Tag #: Medical Record #: Name: Sex: DOB-Age: Triage Category: Procedures Location: Procedures Time: Disposition: Disposition Time: Field Tag #: Medical Record #: Name: Sex: DOB-Age: Triage Category: Procedures Location: Procedures Time: Disposition: Disposition Time: Field Tag #: Medical Record #: Name: Sex: DOB-Age: Triage Category: Procedures Location: Procedures Time: Disposition: Disposition Time: Field Tag #: Medical Record #: Name: Sex: DOB-Age: Triage Category: Procedures Location: Procedures Time: Disposition: Disposition Time: 4. PREPARED by: Date: Time: FACILITY: ------------------------------------ Express Sending Station: Senders Express Version: Senders Template Version: