September 22, 2022

MEDICAL PLAN
ICS 206

1. INCIDENT/EVENT NAME 2. OPERATIONAL PERIOD

From (Date and Time):
To (Date and Time):
3. MEDICAL AID STATIONS
Contact With Paramedics? Remarks
Name Location Contact Person
Number(s) Yes No

4. AMBULANCE/ MEDICAL TRANSPORTATION SERVICES

Contact Level of Service Remarks
Name Location Contact Person
Number(s) BLS ALS

5. HOSPITALS
With With With
Contact Contact Travel Time Trauma Burn Helipad?
Name Location Center? Center?
Person Number(s)
Air Land Yes No Yes No Yes No

6. MEDICAL EMERGENCY PROCEDURES

__ Check if aviation assets are utilized for rescue. If assets are used, coordinate with Air Operations Branch.

Name and Signature: Date Prepared: Time Prepared:

7. Prepared by MEDL

Name and Signature: Date Reviewed: Time Reviewed:

8. Reviewed by SOFR
 September 22, 2022
ICS 206: MEDICAL PLAN

PURPOSE: The ICS 206 provides information on incident medical aid stations, transportation
services, hospitals, and medical procedures primarily intended for the responders.

PREPARATION: The ICS 206 is prepared by the Medical Unit Leader (MEDL) and reviewed by
the Safety Officer (SOFR).

DISTRIBUTION: The ICS 206 is duplicated and attached to the ICS 202 and given to all
recipients as part of the Incident Action Plan (IAP). All completed original forms must be given
to the Documentation Unit.

HOW TO FILL-UP THE FORM:

BLOCK NO. BLOCK TITLE INSTRUCTIONS

1 Incident/Event Name
2 Operational Period
3 Medical Aid Stations
4 Ambulance/Medical
Transportation
Services
5 Hospitals
6 Medical Emergency
Procedures
7 Prepared by MEDL
8 Reviewed by SOFR
Enter the name assigned to the incident/event
Enter the start date (mm-dd-yyyy) and time (24 hour format)
and end date and time for the operational period to which
the form applies.
Enter the relevant information on the incident/field medical
aid station(s). Indicate the name, location, contact person
and contact number(s). Also specify whether or not
paramedics are provided.
Enter the relevant information on the ambulance/medical
transportation service(s). Indicate the name, location,
contact person and contact number(s). Also specify the
level of service if Basic Life Support (BLS) or Advance Life
Support (ALS).
Enter the relevant information on the hospital(s). Indicate
the name, location, contact person and contact number(s).
Also specify the travel time going to the hospital. Further,
indicate if there are trauma center, burn center, and/or
helipad.
Enter any special emergency instructions for use by
incident personnel including (1) who should be contacted,
(2) how should they be contacted, and (3) who manages an
incident within an incident due to a rescue, accident, etc.
Include procedures for reporting medical emergencies.
Enter complete name of the MEDL, signature, date (mm-
dd-yyyy), and time (24 hour format) the form was prepared
and completed.
Enter complete name of the SOFR, signature, date (mm-
dd-yyyy), and time (24 hour format) the form was reviewed.
 September 22, 2022

MEDICAL PLAN
ICS 206

1. INCIDENT/EVENT NAME 2. OPERATIONAL PERIOD

Rizal Earthquake From (Date and Time): 09-17-20xx, 1000H
To (Date and Time): 09-17-20xx, 2200H
3. MEDICAL AID STATIONS
Contact With Paramedics? Remarks
Name Location Contact Person
Number(s) Yes No
Dr National
Bo. Kalaklan Jericho Royalista 12345 /
Station 1

4. AMBULANCE/ MEDICAL TRANSPORTATION SERVICES

Contact Level of Service Remarks
Name Location Contact Person
Number(s) BLS ALS
AMB – 1 Bo. Barretto Peter Piper 45678 /

5. HOSPITALS
With With With
Contact Contact Travel Time Trauma Burn Helipad?
Name Location Center? Center?
Person Number(s)
Air Land Yes No Yes No Yes No
St. Jude Dr. Maja 20
Bo. Subic 98765 / / /
Hospital Salvadore mins

6. MEDICAL EMERGENCY PROCEDURES

__ Check if aviation assets are utilized for rescue. If assets are used, coordinate with Air Operations Branch.

Name and Signature:

Date Prepared: Time Prepared:
7. Prepared by MEDL Gu
09-16-20xx 1500H
Gu Jun Pyo
Name and Signature:
Date Reviewed : Time Reviewed:
8. Reviewed by SOFR Kathryn
09-16-20xx 1700H
Kathryn Bernardo