US MEDICAL STATUS FIELD REPORT [USMEDFLDREP]
LINE 1 — DATE AND TIME______________________________(DTG)
LINE 2 — UNIT________________________________________(Unit Making Report)
LINE 3 — LOCATION___________________________________(Reporting Unit UTM or Six-Digit Grid Coordinate With Grid Zone Designator)
LINE 4 — SHIP_________________________________________(Ship Name (if Required))
LINE 5 — BED STAT
a. OPERATING__________________________________(Number Beds Operating)
b. NO. OCCUPIED_______________________________(Number Beds Occupied)
c. NO. ARMY___________________________________(Number Army Patients)
d. NO. NAVY___________________________________(Number Navy Patients)
e. NO. MARINE_________________________________(Number Marine Patients)
f. NO. AIR FORCE_______________________________(Number Air Force Patients)
g. NO. EPW ____________________________________(Number EPW Patients)
h. NO. US CIVILIAN_____________________________(Number US Civilian Patients)
i. NO. ALLIED CIVILIAN _________________________(Number Allied Civilian Patients)
j. NO. OTHER __________________________________(Number Other Patients)
LINE 6 — STATUS_____________________________________(Patients Status by Service)
a. NO. RTD_____________________________________(Number RTD in 72 Hours)
b. NO. EVAC ___________________________________(Number EVAC to CONUS)
c. NO. DOW____________________________________(Number DOW)
LINE 7 — DAYS CLASS VIII_____________________________(Days of Class VIII OH)
LINE 8 — DAYS BLOOD________________________________(Days Blood Supply OH)
LINE 9 — CHRONIC PROBLEMS_________________________(Chronic Problems)
LINE 10 — NARRATIVE_________________________________(Free Text for Additional Information Required for Clarification of Report)
LINE 11 — AUTHENTICATION___________________________(Report Authentication)
