Figure 4. Travel Requirements (from SMC Form)

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• Pre-departure:
  • Treatment
  • Check
  • Pregnant, EDD dd-MMM-YYYY
  • Hospitalization
• Escort Type:
  • Individual
  • Group
  • Doctor
  • Nurse Specialist: _ _ _ _
  • Non-medical
• Wheelchair:
  • WCHR (Can Walk Up Stairs)
  • WCHS (Not Able to Walk Up Stairs)
  • WCHC (Carry-on)
• In-flight:
  • Extra Seat
  • 3 Seats
  • Stretcher
  • IV Rx
  • Airlift
  • Oxygen, at __ LPM to
  • FD*
  • POE*
• Disability Code:
  • BLND (blind)
  • DEAF
  • MED (medical case)