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Use to provide status on hospitalization, incidence or occurrence of disease, and unresolved problems or items of significant interest having impact upon the overall medical capability or health of the command. The MEDSTAT report must be repeated in its entirety to report the medical status of ashore or afloat units. Reference: FM 8-10-24.

LINE 1 — DATE AND TIME______________________________(DTG)

LINE 2 — UNIT________________________________________(Unit Making Report)

LINE 3 — TYPE________________________________________(Type of Medical Status Report: ASHORE REPORT or AFLOAT REPORT)

LINE 4 — COMMAND__________________________________(Name of Designator of Reporting Command or Facility if Ashore; Ship Name, Type and Hull Number)

LINE 5 — POC_________________________________________(Name of Medical Point of Contact)

LINE 6 — AVAILABLE__________________________________(Number of Cots or Hospital Beds Available)

LINE 7 — OCCUPIED___________________________________(Number of Cots or Hospital Beds Occupied)

LINE 8 — OVERFLOW__________________________________(Number of Cots/Holding Beds Occupied)

LINE 9 — FULL ________________________________________(Number of Cots/Holding Beds Occupied)

LINE 10 — WAITING ___________________________________(Number of Patients Awaiting Evacuation Out of/From Command’s Area of Responsibility Since Last Report)

LINE 11 — MEDLOG____________________________________(Number of Days of Class VIII Supplies on Hand)

LINE 12 — PROBLEMS__________________________________(Unresolved Problems and Anticipated Problems/ Issues Affecting Reporting Command)

LINE 13 — ASSESSMENT________________________________(Commanding Officer’s Assessment of Operational Capabilities and Ability to Continue Medical Support (Mandatory Entry))

LINE 14 — NARRATIVE_________________________________(Free Text for Additional Information Required for Clarification of Report)

**Report lines 3 to 14 as a group when reporting the medical status of more than one command, facility, or ship.

LINE 15 — AUTHENTICATION___________________________(Report Authentication)

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