Emergency Plan Manual

APPENDIX C: SUPPORT MATERIAL PATIENTS WHO NEED CONTINUED SERVICES DURING AN EMERGENCY (Prioritized List) Med. Rec. Patient’s Name and Address Phone Actual Main Services How services will continue Special needs shelter (Y/N) Name/ Address / Phone Medication Equipment list updated (Y/N) Pt needs to be transferred (Y/N) Receive Skilled Care (Y/N) Category: _________ Observation:_________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________