HURRICANE RECOVERY INFORMATION
Resources for Initial Medical Screening and Ongoing Public Health Surveillance in Hurricane Evacuation Centers
- Initial Medical Screening & Ongoing Public Health Surveillance in Evacuation Centers
Guidance for evacuation centers
- Evacuee Medical Intake Form
This interim form is intended to be used for medical intake assessment and triage of evacuees entering a shelter facility or evacuation center. The form can be used to identify evacuees who may need additional medical evaluation and treatment. The first page contains registration information for use by facility, local and state authorities. The remaining pages can be used to anonymously report medical conditions among evacuees.- Download PDF version of the form
(158 KB/5 pages) - Download Word version of the form
(216 KB/5 pages)
Right-click on link above and select Save Target As to save Word document to your computer
- Download PDF version of the form
- Aggregate Hurricane Morbidity Report Form: for Active Surveillance in Facilities Serving Evacuees
Page last modified July 7, 2006