HHo0s

Circumstances of injury(including dates, times, place)Was any warning given to evacuate the building?If so, what time interval between warning and bomb/shell/attack?Medical evacuation• By who, stages including time table, delays, problems, where to, towhat hospital in GS and then through Erez to X, Time between injuryuntil reached hospital in GS (indicate name of hospital):• Problems in Erez (did they go through the field hospital, wherethey pressured there, signed a paper? Any of their accompanyingrelatives not allowed escorting them? Any other comments):• Medical Documents (if received):At the hospitalCurrent medical treatment (indicate surgeries, disabilities etc.):Medical Documentation (reports, images):Any fragments, bullets, etc. taken out during surgery operation?Name of Treating Doctor:Presence of any family members with the patient?How are they supported?Where is the financial support? Does he have medical insurance?When is the patient expected to leave?Does the patient have relatives outside Gaza?Where will the patient go after leaving, and how will he get there?Are there proper facilities at home(water, sanitation accessibility to those):Will the patient need constant healthcare for his injury post discharge?Will the final destination of the patient have health/ mental healthfacilities the patient may need to access?Will the patient have shelter/ relatives in the final destination?Does the patient have a guaranteed family member to care for himpost discharge?If disabled, are there any special facilities(bed, ramps, adaptation at home)?Will the patient be able to resume his original occupation given his injury?222