Patients Medical Evacuation (MEDEVAC) Application

Contact Information




 Request Call Back

 Request Phone Call:


Other Information





 Land Mark:

 Patient Medical Condition:

 Availability of Ground Motor Ambulance?


Flight Document Required

 Current Vital Signs:

 Level of Consciousness:

 Is Patient Intubated?:

 IV Access In Situ?:

 Any Catheterization?:

 Proof of Payment Confirmation?:


 Evidence of Approximate Acceptance of Patient Receiving Hospital?:


 Passports & Copies of Other Travel Documents (same applies to accompanying persons)?:


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