Draft --- Hospital Status Worksheet --- Draft

modified from "9-Line by Steve Hansen KB1TCE Maine ARES State Emergency Coordinator" http://maine-ares.org/9_Line.html
 by David Lowe WE1U, Androscoggin Amateur Radio Emergency Services  http://we1u.us/DRAFT_Hospital_Status_Form_with_Notes.html

Hospital Name and Location:				Date:
	Rooms	Capacity	In Use	Available(and comments)
1	Adult ICU
2	Adult Medical/Surgical
3	Burn Unit
4	PICU(Pediatric ICU)
5	Pediatrics Medical/Surgical
6	Maternity(OB)
7	Psychiatric-Adult
8	Psychiatric-Pediatric
9	Psychiatric-Substance Abuse
10	Negative Pressure/Isolation
11	Ventilator
12	Operating Rooms
13	Triage Tag- Green
14	Triage Tag- Yellow
15	Triage Tag- Red
16	Notes: