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MEDICAL EVACUATION REQUEST [MEDEVAC]

Use to request evacuation of sick and wounded personnel by other than USAF fixed-wing assets. Reference: FM 8-10-6.

LINE 1 -- DATE AND TIME______________________________(DTG)

LINE 2 -- UNIT________________________________________(Unit Making Report)

LINE 3 -- LOCATION___________________________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator) of Pickup Site Location; Encrypt if Using Non-Secure Means of Communication)

LINE 4 -- RADIO FREQUENCY___________________________(Radio Frequency at Pickup Site; Call Sign, and Suffix)

LINE 5 -- NUMBER OF PATIENTS(P)______________________(Number of Patients by Precedence. Report Only Applicable Information and Encrypt the Brevity Codes:
A -- URGENT
B -- URGENT-SURG
C -- PRIORITY
D -- ROUTINE
E -- CONVENIENCE)
If two or more categories must be reported in the same request, insert the word BREAK between each category.)

LINE 6 -- SPECIAL EQUIPMENT__________________________(Encrypt the Applicable Brevity Codes.
A -- None
B -- Hoist
C -- Extraction Equipment)

LINE 7 -- NUMBER OF PATIENTS(T)______________________(Total Number of Patients by Type. L + # of PNT -- Litter / A + # of PNT -- Ambulatory)

LINE 8 -- SECURITY OF PICK-UP SITE____________________(N -- No Enemy Troops in Area
P -- Possibly Enemy Troops in Area (approach with caution)
E -- Enemy Troops in Area (approach with caution)
X -- Enemy Troops in Area (armed escort required))

LINE 9 -- NO. TYPE OF WOUND, INJURY, OR ILLNESS (PEACETIME)

_____________________________________________________(Specific Information Regarding Patient Wounds by Type)

LINE 10 -- METHOD OF MARKING AT PZ_________________(Encrypt the Brevity Codes:
A -- Panels
B -- Pyrotechnic signal
C -- Smoke Signal
D -- None
E -- Other)

LINE 11 -- PATIENT NATIONALITY ______________________(Number of Patients in Each
Category Need Not be Transmitted. Encrypt Only the Applicable Brevity Codes:
A -- US Military
B -- US Civilian
C -- Non-US Military
D -- Non-US Civilian
E -- EPW)

LINE 12 -- NBC CONTAMINATION ______________________(NBC Contamination; Use Brevity Codes:
N = Nuclear
B = Biological
C = Chemical
U = Unknown
A = All Clear)

LINE 13 -- TERRAIN DESCRIPTION ______________________(Description of Terrain Features at the Proposed Pick-up Site)

LINE 14 -- AUTHENTICATION___________________________(Report Authentication)