LA Hospital Bed Report

DEPARTMENT OF HEALTH SERVICES COUNTY OF LOS ANGELES
SUBJECT: BED AVAILABILITY REPORT		(HOSPITALS) REFERENCE NO. 1122.1

Hospital Name:

Hospital Service Level: Time of HSL:

BED AVAILABILITY		# Available Immediately	# Available within 24 Hours Complete only when checked	# Available within 72 Hours Complete only when checked
1	Medical/Surgical
2	Telemetry
3	Adult ICU
4	Pediatric ICU
5	Neonatal ICU
6	Pediatric Bed
7	Obstetrics/Gynecology
8	Trauma
9	Burn
10	Negative Pressure/Isolation
11	Psychiatric
12	Operating Room
13
14	Ventilator
15	Mass Decontamination Facility Available	YES NO

	Report Completed by:
	PHONE NUMBER
	Report DATE /Time

Addtional Comments:
MapFileName:T=j2 Latitude:T=j5 Longitude:T=j6 MGRS:T=j7 00a. Grid: Grid:T=j8 00b. What3Words:T=j9 00c. Hospital name: T=j1 00d. Service Level:M:GREEN-Normal Operations,YELLOW-Under Control,ORANGE-Modified Service,RED-Limited Service,BLACK-Impaired Service,GREY-Unknown=j3 00e. Time of HSL:T=j4 01. Medical/Surgical:N=j10 02. Telemetry:N=j11 03. Adult ICU:N=j12 04. Pediatric ICU:N=j13 05. Neonatal ICU:N=j14 06. Pediatric Bed:N=j15 07. Obstetrics/Gynecology:N=j16 08. Trauma:N=j17 09. Burn:N=j18 10. Negative Pressure/Isolation:N=j19 11. Psychiatric:N=j20 12. Operating Room:N=j21 13. Other j22:N=j23 14. Ventilator:N=j24 15. Mass Decontamination Facility Available:M:YES,NO=j25 16. Report Completed by:T=j26 17. PHONE NUMBER:T=j27 18. Report Date/Time:T=j28 19. Additional Comments:T=j29

FAX COMPLETED FORM TO THE MEDICAL ALERT CENTER
AT (562) 906-4300
OR
SEND TO LAC-MAC VIA WINLINK
WITHIN 60 MINUTES OF REQUEST

EFFECTIVE: 03-19-09
REVISED: 10-01-20
SUPERSEDES: 04-01-18

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