(9) Block 9 .
Write in information requested.
NOTE: If additional space is required, use Block 14.
(10) Block 10.
(a) Check appropriate box.
(b) Write in date and time of disposition.
(11) Block 11.
(a) Write signature and unit of medical officer completing form.
(b) Write in initials of combat medics initiating form on the right side of
(12) Block 12.
(a) Write in date and time of arrival.
(b) Record blood pressure, pulse, and respirations in space provided.
(13) Block 13.
Document appropriate comments by date and time of observation.
(14) Block 14.
(a) Document provider's orders by date and time.
(b) Record dose of tetanus administered and time administered.
(c) Record type and doses of antibiotic administered and time
(15) Block 15.
(a) Write in signature of provider or medical officer.
(b) Enter date and time.