a) Name and telephone of the person who is requesting the removal;
b) Name, age and sex of the patient;
c) City where the patient is;
d) Name and telephone of the hospital where the patient is;
e) Name and telephone of the patient's doctor;
f) City where the patient will go;
g) Name and telephone of the patient's destination hospital;
h) Name and telephone of the doctor who will assist the patient at the destination (if known).
