Medical intake form for Hurricane Katrina evacuees
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Medical intake form for Hurricane Katrina evacuees

Filetype[PDF-382.44 KB]


  • English

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    • Description:
      Thursday, September 08, 2005, 13:15 EDT (1:15 PM EDT)

      CDCHAN-00234-2005-09-08-ADV-N

      Announcement for HAN ; 235: Tool for surveillance among facilities housing Hurricane Katrina evacuees.

      This interim form is intended to be used for medical intake assessment and triage of evacuees entering a shelter facility or evacuation center. The form can be used to identify evacuees who may need additional medical evaluation and treatment. The first page contains registration information for use by facility, local, and state authorities. The remaining pages can be used to anonymously report medical conditions among evacuees.

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