Recommendations for a National Mass Patient and Evacuee Movement, Regulating, and Tracking System

You Are Here: AHRQ Archive Home > Public Health Preparedness Archive > Recommendations for a National Mass Patient and Evacuee Movement, Regulating, and Tracking System

This resource was developed by AHRQ as part of its Public Health Emergency Preparedness program, which was discontinued on June 30, 2011. Many of AHRQ's PHEP materials and activities will be supported by other Federal agencies. Notice of transfer to another agency will be posted on this site.

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to www.ahrq.gov for current information.

Exhibit D.1: "Sister" Hospital Tracking Form

The first eight columns are populated from automated patient registration system/discharge at the evacuating hospital; the next eight are populated by nursing staff hard copy and then entered into the system; and the last columns are populated at the receiving hospital from its patient registration system.

Date

Patient Evacuation							Total Census		Total ER Pts	Total OR Cases in Prog.		Total Transferred to Other Facilities
This row updates continuously =>							0		0	0		0
Last Name	First Name	Nursing Station	Room-Bed	Age	Sex	Diagnosis	Attending Physician	D/C Home	Destination Facility	Room # at Receiving Facility	Chart Ready on Floor	Time pt ready to go to staging area	Type of transport: ALS or BLS

Date

Patient Evacuation							Total to CCH	Total to HRMC		Total to PBCH		Total to WMH		Total to SNF		Total to Other	Totel Discharges
This row updates continuously =>							0	0		0		0		0		0	0
Last Name	First Name	Nursing Station	Room-Bed	Age	Sex	Diagnosis	Medical Record final check complete in staging area	Time Left Sending Facility	Time Arrived Receiving Facility	IV	O2	(S)tretcher or (W)heelchair	Vent	Monitor	Isolation type or precaution	Receiving Physician	Additional Comments

Return to Document

The information on this page is archived and provided for reference purposes only.