or call 800-355-4628
The Evacuee Information & Tracking Form records vital information from initial assessment to the point of departure. The form includes critical care information such as allergies, primary diagnosis and relevant co-morbidities, and level of consciousness as well as transportation information such as means of transport, accepting facility, and last actions prior to departure. The top copy leaves with the evacuee and the bottom copy remains for medical records.
Available to restock your PACE Evacuation Toolbox (IC3000) or to add to your own evacuation plan supplies.
- Evacuee Information & Tracking Form (IC3005)
Evacuee Information & Tracking Form (IC3005)
- Each form has one yellow duplicate copy
- Pack of 25 forms