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)

3. Discharged Patients (before surge)(Required)

4. Occupied Beds after discharged patients(Required)

(The sum of question 3 and 4 should = total of question 2)

5. Total number of patients received from surge (injects plus accepted from other facilities)(Required)

Must = the sum of Green, Yellow, Red, Black

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

(this includes occupied beds after discharged patients plus surge patients who received a bed)

7. Transferred Patients(Required)

Facility

Transferred Patients

Total number of patients transferred to another facility.