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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)

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