Medical Supplies
Full Name
Email
*
Rank
Date of Request
Station/Location
Medical Supplies Request Section
List of Medical Supplies Needed (itemized)
Quantity of Each Item
Urgency/Priority Level
Low
Medium
High
Critical
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If Replenishing from a Run → Associated Run Number
Medical Equipment Issue Section
Type of Equipment
Cardiac Monitor
AED
Lucas Device
Other
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List is empty.
Equipment ID / Serial Number
Description of Issue
Status of Equipment
In Service
Out of Service
Needs Repair
Battery Replacement Needed
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List is empty.
Additional Notes/Comments
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