MEDEVAC REQUEST FORM GTA 08-01-004
LINE ITEM EVACUATION REQUEST MESSAGE
1 Location of Pickup Site.
2 Radio Frequ., Call Sign, & Suffix.
3 No. of Patients by Precedence.
4 Special Equipment Required.
5 Number of Patients by Type.
6 Security of Pickup Site (Wartime).
6 Number and Type of Wound,
Injury, or Illness (Peacetime).
7 Method of Marking Pickup Site.
8 Patient Nationality and Status.
9 NBC Contamination (Wartime).
9 Terrain Description (Peacetime).
This publication contains technical or operational information that is for official Government use only. Distribution is limited to U.S. Gover nment agencies. Requests from outside
U.S. Government agencies for release of this publication under the Freedom of Information Act or the Foreign Military Sales Program must be made to Commander USATSC,
ATTN: GTA Program Manager ATIC-ITST-T, Fort Eustis, VA 23064-5166. DESTRUCTION NOTICE: Destroy by any method that will prevent disclosure of contents or
reconstruction of document.
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AUG 2002 (This supersedes GTA 08-01-004 MAY 1997) DISTRIBUTION: US ARMY TRAINING SUPPORT CENTERS (TSCs)
HEADQUARTERS, DEPARTMENT OF THE ARMY,
ATTN: ATIC -ITST -T, GTA Program, Fort Eustis, VA 23604-5166
