Skip Navigation U.S. Department of Health and Human Services www.hhs.gov
Agency for Healthcare Research Quality www.ahrq.gov
Archive print banner
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 It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work.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.

 

AHRQ Advancing Excellence in Health Care