77.
SPECIAL DIET/TYPE: Report whether patient requires special diet and if so, report type of diet.
78.
IV/TYPE: Report intravenous requirement, if any, and type.
79.
BLOOD/UNIT:
Report patient's requirement for whole blood and number of units required while en
route.
80.
TRACH/SIZE: Report whether or not tracheotomy is in place. If so, report size.
81.
CAST/TYPE AND LOCATION:
Report whether patient is in cast. If so, report type and anatomical
location.
82.
CANX/INCOMPLETE: DPEO and PAC use only.
83.
OTHER: Report pertinent information pertaining to patient not provided elsewhere.
84.
CMTs: DPEO and PAC use only.
85.
TRANS ORIG PHONE: Provide the telephone number of the office arranging transportation to the
aircraft at the point of origin.
86.
TRANS DEST PHONE: Provide the telephone number of the office arranging transportation from the
aircraft to the destination hospital.
87.
MISSION NO:
PAC use only.
88.
RON LOCATION: PAC use only.
89.
VALIDATED BY/REASON HIGHER PRECEDENCE :
PAC use only.
Table 3-2. Telephone Reporting Format (concluded).
d. A request for hospital designation will include the patient's name, grade or status,
appropriate alphabetical and numerical coding, special medical requirements, and any
additional personal or administrative information which will clarify the needs or special
requirements of the patients. For a member patient, the request will include the duty
station (or home port for ship) if the patient is expected to return to duty or the place of
residence (not necessarily the home of record) for a member who is not expected to return
to duty. For a nonmember patient, the place of residence is specified. Modifications in
the data provided are necessary for patients to be transferred to Veterans Administration
hospitals (see figure 3-5).
MD0752
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