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Use to convey a quick, consolidated medical status report as a snapshot rather than a full report. Reference: FM 8-10-3.

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)

LINE 4 -- STATUS______________________________________(Number of Operational Cots, Unoccupied Cots, Number of Cots Uploaded)

LINE 5 -- PATIENTS____________________________________(Number of Patients)

LINE 6 -- PROJECTED LOCATIONS_______________________(Anticipated Operations in the Next 24 Hours; Anticipated Opening and Closing Times at New Locations)

LINE 7 -- COMBAT HEALTH LOGISTICS__________________(Number of Days Class
VIII Blood OH)

LINE 8 -- EVACUATION ASSETS ________________________(Availability and Operational Capacity of Evacuation

LINE 9 -- NARRATIVE__________________________________(Free Text for Additional Information Required for Clarification of Report

LINE 10 -- AUTHENTICATION___________________________(Report Authentication)