Emergency Medical Evacuation Disembarkation Card
Personal Information
Full Name
Date of Birth
Passport/ID No.
Nationality
Gender
Contact Number
Evacuation Details
Evacuation Flight No.
Date of Evacuation
From (Location)
To (Location)
Medical Information
Medical Condition
Special Care/Assistance Required
Additional Notes
Attending Doctor/Nurse (Name)
Medical Facility
Signature
Date