CERT-G 9-LINE MEDEVAC REQUEST CERT GROUP, INC. | 7550 AIRWAYS RD. | PO BOX 1112 | SOUTHAVEN, MS. 38671 LINE RESPONSE 1 2 3 A: URGENT B: URGENT SURGICAL C: PRIORITY D: ROUTINE 4 A: NONE B: HOIST D: VENTILATOR 5 6 7 8 9 N/A E: EPW / MILITARY ENEMY COMBATANT 1C / 3E A: LITTER B: AMBULATORY NBC CONTAMINATION AND/OR TERRAIN TYPE 16S BD 26311 73779 -146.685 / KG5CHK E: AT CONVENIENCE C: EXTRACTION EQUIPMENT A: NO ENEMY COMBATANT FORCE (ECF) IN AREA B: POSSIBLE ECF IN AREA - APPROACH WITH CAUTION C: ECF IS IN AREA - APPROACH WITH CAUTION D: ECF IS IN AREA - ARMED ESCORT REQUIRED PATIENT NATIONALITY AND STATUS A: US MILITARY / CERT GROUP SECURITY MEMBER B: US CIVILIAN / CERT GROUP NON-SECURITY TEAM MEMBER C: NON-US MILITARY / CERT GROUP ALLY COMBATANT D: NON-US CITIZEN / NON-CERT GROUP CIVILIAN METHOD OF MARKING PICK-UP SIRE A A: PANELS B: PYROTECHNIC SIGNAL C: SMOKE SIGNAL SECURITY AT PICK-UP SITE? 4A # OF PATIENTS BY PRECEDENCE? ANY SPECIAL EQUIPMENT REQUIRED? NUMBER OF PATIENTS BY TYPE? B 3A / 1B A ITEM DESCRIPTION LOCATION OF PICK-UP SITE? RADIO FREQ, CALL SIGN, SUFFIX? D: NONE E: OTHER
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CERT-G 9-LINE MEDEVAC REQUEST
CERT GROUP, INC. | 7550 AIRWAYS RD. | PO BOX 1112 | SOUTHAVEN, MS. 38671
LINE RESPONSE1
2
3A:URGENT B:URGENTSURGICAL C:PRIORITYD:ROUTINE4A:NONE B:HOISTD:VENTILATOR5
6
7
8
9N/A
E:EPW/MILITARYENEMYCOMBATANT
1C/3E
A:LITTERB:AMBULATORY
NBCCONTAMINATIONAND/ORTERRAINTYPE
16SBD2631173779
-146.685/KG5CHK
E:ATCONVENIENCE
C:EXTRACTIONEQUIPMENT
A:NOENEMYCOMBATANTFORCE(ECF)INAREAB:POSSIBLEECFINAREA-APPROACHWITHCAUTIONC:ECFISINAREA-APPROACHWITHCAUTIOND:ECFISINAREA-ARMEDESCORTREQUIRED
PATIENTNATIONALITYANDSTATUSA:USMILITARY/CERTGROUPSECURITYMEMBERB:USCIVILIAN/CERTGROUPNON-SECURITYTEAMMEMBERC:NON-USMILITARY/CERTGROUPALLYCOMBATANTD:NON-USCITIZEN/NON-CERTGROUPCIVILIAN
METHODOFMARKINGPICK-UPSIRE
A
A:PANELSB:PYROTECHNICSIGNALC:SMOKESIGNAL
SECURITYATPICK-UPSITE?
4A
#OFPATIENTSBYPRECEDENCE?
ANYSPECIALEQUIPMENTREQUIRED?
NUMBEROFPATIENTSBYTYPE?
B
3A/1B
A
ITEMDESCRIPTIONLOCATIONOFPICK-UPSITE?
RADIOFREQ,CALLSIGN,SUFFIX?
D:NONEE:OTHER
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