HEF

Hospital Patient Tracking and Transfer Form

Facility Name(Required)

Evaluator Name(Required)

First Last

Evaluator Email(Required)

1. Total Staffed Beds at the beginning of exercise(Required)

2. Total Occupied Beds at the beginning of exercise(Required)

Total Number of patients received from Injects (must = the sum of Green, Yellow, Red, Black)(Required)

Existing patients maintain a bed(Required)

Discharged Patients(Required)

End of exercise total # of patients that received an appropriate bed(Required)

(Must be = or greater than total patients requiring a bed. Total surge plus existing patients maintaining a bed. )

Transferred Patients(Required)

Facility

Transferred Patients

Total Number of patients transferred to another coalition facility