HICS 206 – STAFF MEDICAL PLAN<br>
1. INCIDENT NAME 206 incident<br>
2. DATE PREPARED 2011-11-01<br>
3. TIME PREPARED 0749L<br>
4. OPERATIONAL PERIOD DATE/TIME til the twelfth of never<br>
5. TREATMENT OF INJURED / STAFF<br>
   Location of Staff Treatment Area <br><br>
   Contact Information <br><br>
   Treatment Area Team Leader <br><br>
   Contact Information <br><br>
   Special Instructions be kind and gentle<br><br>
6. RESOURCES ON HAND<br>
   STAFF<br>
     MD/DO: <br>
     PA/NP: <br>
     RN/LPN: <br>
     Technicians/CN: <br>
     Ancilliary/Other: <br>
   MEDICAL TRANSPORTATION <br>
     Litters: <br>
     Portable: <br>
     Transport: <br>
     Wheelchairs: <br>
     Other: <br>
   MEDICATION<br>
     <br>
     <br>
     <br>
     <br>
     <br>
   SUPPLIES<br>
     <br>
     <br>
     <br>
     <br>
     <br>
7. ALTERNATE CARE SITE(S)<br>
   NAME:      <br>
   ADDRESS:   <br>
   PHONE:     <br>
   SPEC CARE: <br>
   NAME:      <br>
   ADDRESS:   <br>
   PHONE:     <br>
   SPEC CARE: <br>
   NAME:      <br>
   ADDRESS:   <br>
   PHONE:     <br>
   SPEC CARE: <br>
   NAME:      <br>
   ADDRESS:   <br>
   PHONE:     <br>
   SPEC CARE: <br>
8. PREPARED BY (SUPPORT BRANCH DIRECTOR): dave<br>
9. FACILITY NAME whitfield<br>
