US Army Medical Course MD0752-101 - Patient Accountability Branch

U. S.
ARMY MEDICAL DEPARTMENT CENTER AND SCHOOL

FORT SAM HOUSTON, TEXAS 78234
MD0752
PATIENT ACCOUNTABILITY
BRANCH
EDITION 101
DEVELOPMENT
This subcourse reflects the current thought of the Academy of Health Sciences and
conforms to printed Department of the Army doctrine as closely as currently possible.
Development and progress render such doctrine continuously subject to change.
When used in this publication, words such as "he," "him," "his," and "men" are intended to
include both the masculine and feminine genders, unless specifically stated otherwise
or when obvious in context.
The contractor responsible for the development of this subcourse was Advanced
Development Group. The instructional systems specialist responsible for overseeing
development was Mr. Richard Smart, DSN 421-9931; commercial (210) 295-9931, and the
subject matter expert responsible for content accuracy was SFC Mark Minter, DSN 471-
0944; commercial (210) 221-0944, COMMANDER, U.S. ARMY MEDICAL DEPARTMENT
CENTER AND SCHOOL, DEPARTMENT OF HEALTHCARE OPERATIONS, ATTN:
MCCS-HHP, 3151 SCOTT ROAD, FORT SAM HOUSTON, TX 78234-6100.
ADMINISTRATION
Students who desire credit hours for this correspondence subcourse must meet eligibility
requirements and must enroll through the Nonresident Instruction Branch of the U.S. Army
Medical Department Center and School (AMEDDC&S).
Application for enrollment should be made at the Internet website: http://www.atrrs.army.mil.

You can access the course catalog in the upper right corner. Enter School Code 555 for
medical correspondence courses. Copy down the course number and title. To apply for
enrollment, return to the main ATRRS screen and scroll down the right side for ATRRS
Channels. Click on SELF DEVELOPMENT to open the application and then follow the on
screen instructions.
In general, eligible personnel include enlisted personnel of all components of the U.S. Army
who hold an AMEDD MOS or MOS 18D. Officer personnel, members of other branches of
the Armed Forces, and civilian employees will be considered eligible based upon their AOC,
NEC, AFSC or Job Series which will verify job relevance. Applicants who wish to be
considered for a waiver should submit justification to the Nonresident Instruction Branch at
e-mail address: accp@amedd.army.mil.
For comments or questions regarding enrollment, student records, or shipments, contact

the Nonresident Instruction Branch at DSN 471-5877, commercial (210) 221-5877, toll-free
1-800-344-2380; fax: 210-221-4012 or DSN 471-4012, e-mail accp@amedd.army.mil, or
write to:
NONRESIDENT INSTRUCTION BRANCH

AMEDDC&S
ATTN: MCCS-HSN
2105 11TH STREET SUITE 4191
FORT SAM HOUSTON TX 78234-5064
TABLE OF CONTENTS
Lesson Paragraphs Page
INTRODUCTION ......................................................................... v
1 ADMISSION AND DISPOSITION PROCESSING ..................... 1-1--1-19 1-1
Section I. Reception, Identification, and Definition ............. 1-1--1-3 1-2

Section II. Admission Processing............................................ 1-4--1-12 1-6
Section III. Special Reporting Requirements .......................... 1-13--1-14 1-35
Section IV. Admission and Disposition Report ....................... 1-15--1-17 1-37
Section V. Disposition Processing .......................................... 1-18--1-19 1-50
Exercises ................................................................................... 1-52
2 ABSENT SICK PROCESSING.................................................... 2-1--2-8 2-1
Section I. Administration of Army Military Patients in

Civilian Medical Treatment Facilities (MTF)......... 2-1--2-4 2-2
Section II. Payment of Civilian Facilities................................. 2-5--2-8 2-3
Exercises ................................................................................... 2-8
3 MEDICAL REGULATING AND AEROMEDICAL EVACUATION 3-1--3-30 3-1
Section I. Introduction............................................................... 3-1--3-9 3-2

Section II. Peacetime Procedures and Responsibilities ...... 3-10--3-16 3-8
Section III.Preparation of Requests and Forms for Transfer ..... 3-17--3-22 3-21
Section IV. Combat Procedures for Regulating and
Evacuating Patients ................................................ 3-23--3-30 3-43
Exercises ................................................................................... 3-52
4 MEDICAL SERVICES ACCOUNT.............................................. 4-1--4-15 4-1
Section I. Introduction............................................................... 4-1--4-2 4-2

Section II. Medical Services Account Forms and Files......... 4-3--4-4 4-3
Section III.Inpatient Ledger Card Procedures............................. 4-5--4-6 4-12
Section IV. Disposition Processing .......................................... 4-7--4-10 4-17
Section V. Month-End Processing ........................................... 4-11--4-12 4-21
Section VI. Other Procedures .................................................... 4-13--4-15 4-23
Exercises .................................................................................... 4-25
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5 PATIENTS' TRUST FUND ............................................................ 5-1--5-11 5-1
Section I. Introduction and Principles .............................................5-1--5-5 5-2

Section II. Forms and Transactions .................................................5-6--5-11 5-7
Exercises ........................................................................................ 5-25
GLOSSARY ........................................................................................ G-1
EXAMINATION.................................................................................... Exam-1
LIST OF ILLUSTRATIONS
Figure Page
1-1 DD Form 689 (Individual Sick Slip)..................................................................... 1-9

1-2 Sample register number log................................................................................. 1-10
1-3 DA Form 2985 (Admission and Coding Information) ....................................... 1-11
1-4 Sample nine-line addressograph plate (patient data card).............................. 1-26
1-5 Sample embossed nursing unit or clinic identification plate,
inpatient identification plate, and patient recording card ............................. 1-27
1-6 Sample wrist identification band ......................................................................... 1-28
1-7 DA Form 3696 (Patient's Deposit Record)........................................................ 1-29
1-8 DA Form 3153 (MSA Patient Ledger Card)...................................................... 1-30
1-9 DA Form 3647-1 (Inpatient Treatment Record Cover Sheet) .......................... 1-31
1-10 DA Form 4029 (Patient's Clearance Record) ................................................... 1-32
1-11 DA Form 3444 Series (Treatment Record) ....................................................... 1-33
1-12 Sample bed card................................................................................................... 1-34
1-13 Sample of AAD listing required for NATO patients........................................... 1-47
1-14 Sample admission and disposition report ......................................................... 1-48
2-1 Sample of completed SF 1034 (Public Voucher for Purchases and
Services Other Than Personal) ....................................................................... 2-5
3-1 Advantages and benefits of aeromedical evacuation....................................... 3-5
3-2 DA Form 3981 (Transfer of Patient) ................................................................... 3-12
3-3 Memorandum for Aircraft Commander Aeromedical Evacuation Mission..... 3-20
3-4 ASMRO Form 1 (Defense Patient Evacuation Office Data
Input Sheet)........................................................................................................ 3-22
3-5 DD Form 173 (Joint Messageform--Request for Hospital Designation
from CONUS MEDCEN) ................................................................................. 3-29
3-6 DD Form 173 (Joint Messageform--Consolidated Request for CONUS
Hospital Designation from Overseas Theater Patient Movement
Requirements Center)...................................................................................... 3-31
3-7 DD Form 173 (Joint Messageform--Reply from GPMRC to
Consolidated Request) .................................................................................... 3-32
3-8 DD Form 600 (Patient's Baggage Tag) ............................................................. 3-38
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Figure ......... Page
3-9 DD Form 602 (Patient Evacuation Tag)............................................................. 3-40

3-10 Levels of health service support .......................................................................... 3-44
4-1 DA Form 3153 (MSA Patient Ledger Card)...................................................... 4-4
4-2 DA Form 3154 (MSA Invoice and Receipt) ....................................................... 4-5
4-3 DA Form 3929 (MSA Accounts Receivable Register and
Control Ledger)................................................................................................. 4-6
4-4 DA Form 3155 (MSA Cash Record) .................................................................. 4-7
4-5 DA Form 3156 (Statement of MSA Accountable Patient Days and
Reimbursement Earned).................................................................................. 4-8
4-6 DD Form 1131 (Cash Collection Voucher)........................................................ 4-9
4-7 DD Form 139 (Pay Adjustment Authorization)................................................... 4-10
4-8 SF 1080 (Voucher for Transfers Between Appropriations
and/or Funds ..................................................................................................... 4-11
4-9 DA Form 3153, Patient Identification Section ................................................... 4-13
4-10 DA Form 3153, Control Codes and Patient's Daily Hospital
Record Section................................................................................................. 4-14
4-11 DA Form 3153, Daily Rate of Charges Section................................................ 4-15
4-12 DA Form 3153, Billing Data Section .................................................................. 4-16
4-13 Suggested format for letter used to prepare DA Form 4187 ........................... 4-18
4-14 Relationship between DA Forms 3153 and 3154............................................. 4-20
4-15 Completed SF 1080 (Voucher for Transfers Between Appropriations
and/or Funds) .................................................................................................... 4-23
5-1 Statements of outgoing and new custodians ..................................................... 5-6
5-2 DA Form 3696 (Patient's Deposit Record)........................................................ 5-9
5-3 DD Form 599 (Patient's Effects Storage Tag) .................................................. 5-10
5-4 DA Form 3983 (Patients' Trust Fund - Authorization for Deposit
or Withdrawal of Funds and Valuables) ......................................................... 5-12
5-5 DA Form 4665-R (Patients' Trust Fund - Daily Summary Record
(Front)) ............................................................................................................... 5-18
5-6 DA Form 4128 (Patients' Trust Fund Journal) ................................................... 5-21
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LIST OF TABLES
Table Page
1-1A TO&E hospital codes............................................................................................ 1-12

1-1B MTF codes............................................................................................................. 1-13
1-2 Sample of authorized grade abbreviations and data codes ............................ 1-14
1-3 Race codes............................................................................................................ 1-15
1-4 Ethnic background ................................................................................................ 1-16
1-5 Sample of authorized religion abbreviations...................................................... 1-16
1-6 Length of service ................................................................................................... 1-17
1-7 Family member prefix........................................................................................... 1-18
1-8 Marital status.......................................................................................................... 1-18
1-9 Department/Type of Beneficiary.......................................................................... 1-19
1-10 Source of Admission ............................................................................................ 1-21
1-11 MEPRS Clinic Service ........................................................................................ 1-23
3-1 Classification of patients ...................................................................................... 3-14
3-2 Telephone reporting format.................................................................................. 3-24
MD0752 iv
CORRESPONDENCE COURSE OF
THE U.S. ARMY MEDICAL DEPARTMENT CENTER AND SCHOOL
SUBCOURSE MDO752
PATIENT ACCOUNTABILITY BRANCH
INTRODUCTION
When an individual enters the hospital, the personnel in the admission and disposition
section, patient accountability branch, and patient administration division are generally the
first hospital personnel the individual meets. The processing of patients through this
section contributes directly to the efficient operation of the hospital. The reporting of
patient information is not confined to just those in the medical treatment facility (MTF) but
also to those in civilian facilities within the area of responsibility of the MTF.
Patients often need a level of treatment not available in the MTF and may require
evacuation to another MTF. Planning and carrying out the evacuation of patients and
regulating the movement of patients requires detailed knowledge of the evacuation
process and the procedures involved.
The financial accounting for patients is the responsibility of the Medical Services
Account. The safeguarding of the funds and valuables of patients is the responsibility of
the Patients' Trust Fund.
The purpose of this subcourse is to familiarize you with the procedures and the
processing of patients into and out of the hospital; the evacuation of patients; the
accountability of patients; and the safeguarding of the possessions of patients.
Subcourse Components:
This subcourse consists of five lessons and an examination. The lessons are:
Lesson 1, Admission and Disposition Processing.
Lesson 2, Absent Sick Processing.
Lesson 3, Medical Regulating and Aeromedical Evacuation.
Lesson 4, Medical Services Account.
Lesson 5, Patients' Trust Fund.
MD0752 v
Credit Awarded:
Upon successful completion of this subcourse, you will be awarded 25 credit hours.
Lesson Materials Furnished:
Lesson materials provided include this booklet, an examination answer sheet, and an
envelope. Answer sheets are not provided for individual lessons in this subcourse
because you are to grade your own lessons. Exercises and solutions for all lessons are
contained in this booklet. You must furnish a #2 pencil.
Procedures for Subcourse Completion:
You are encouraged to complete the subcourse lesson by lesson. When you have
completed all of the lessons to your satisfaction, fill out the examination answer sheet and
mail it to the AMEDDC&S along with the student comment sheet in the envelope provided.
Be sure that your social security number is on all correspondence sent to the
AMEDDC&S. You will be notified by return mail of the examination results. Your grade on
the exam will be your rating for the subcourse.
Study Suggestions:
Here are some suggestions that may be helpful to you in completing this subcourse:
--Read and study each lesson carefully.
--Complete the subcourse lesson by lesson. After completing each lesson, work the
exercises at the end of the lesson, marking your answers in this booklet.
--After completing each set of lesson exercises, compare your answers with those on
the solutions which follow the exercises. If you have answered an exercise incorrectly,
reread the text material cited after the solution to determine why your response was not the
correct one.
MD0752 vi
--As you successfully complete each lesson, go on to the next. When you have
completed all of the lessons, complete the examination, marking your answers in this
booklet. When you are satisfied that you have answered all of the examination items to the
best of your ability, transfer your responses to the examination answer sheet. Use a #2
pencil to mark the examination answer sheet.
Student Comment Sheet:
Be sure to provide us with your suggestions and criticisms by filling out the student
comment sheet found at the back of this booklet, and returning it to us with your
examination answer sheet. In this way, you will help us to improve the quality of this
subcourse.
If you wish a personal reply to a question, please call or write your question on a
separate letter (not the Student Comment Sheet). The letter can be sent with the
examination answer sheet. Be sure to include your name, rank, social security number,
mailing address, and subcourse number on your letter.
MD0752 vii
LESSON ASSIGNMENT
LESSON 1 Admission and Disposition Processing.
TEXT ASSIGNMENT Paragraphs 1-1 through 1-19.
TASKS TAUGHT 081-866-0003, Verify the Eligibility of Patient.

081-866-0122, Prepare an Admission and Disposition
(AAD Report).
081-866-0118, Prepare a Patient Admission Packet.
LESSON OBJECTIVES After completing this lesson, you should be able to:
1-1. Identify the five types of admission.
1-2. Define the term “disposition.”
1-3. Assign and record register numbers in the register

log.
1-4. Given a situation, prepare DA Form 2985 (Admission

and Coding Information) for admission of a patient to an
Army medical treatment facility (MTF).
1-5. Given a DA Form 2985 of a patient that has been

admitted, identify the information entered on each line of
the nine-line plate.
1-6. Identify the categories of patients which require

special reporting to the Health Services Command.
1-7. Given a patient transaction, identify the major and

subheading of the transaction reported on the admission
and disposition report.
SUGGESTION After studying the assignment, complete the exercises of

the lesson. These exercises will help you to achieve the
lesson objectives.
MD0752 1-1
LESSON 1
ADMISSION AND DISPOSITION PROCESSING
Section I. RECEPTION, IDENTIFICATION, AND DEFINITION
1-1. RECEPTION OF THE PATIENT
a. Attitude. The reception given by professional and administrative personnel when

a patient first enters the hospital strongly influences the patient’s attitude toward the
hospital and the medical care provided. As an admission clerk who interviews the patient,
you will probably create the first administrative impression that the patient will receive. An
excellent opportunity to establish and maintain good patient relationship is offered at the
time of admission. The patient who is anxious, depressed, or in pain should be put at ease
and made as comfortable as possible. As you complete admission forms, speak in a low,
unhurried tone and focus attention on the patient. Give directions clearly and repeat those
that you feel are not understood. Do not comment on facts which the patient furnishes you.
b. Information. Avoid summarizing hospital regulations, such as the policy for

passes and visitors. This type of orientation is provided for patients on the nursing unit and
the patient should be so informed. Most hospitals have an information booklet directed to
the patient.
c. Essential Admission Processing. Patients requiring immediate emergency

care are admitted directly to the treatment setting or service and admission processing is
performed secondary to treatment. Deaths in the emergency room and deaths classified
as dead on arrival (DOA) are not recorded as admissions but are carded for record only
(CRO). Procedures are locally developed for the admission of prisoners, patients with
contagious diseases (for example, tuberculosis), patients with psychiatric conditions, and
victims of disasters.
(1) Review DA Form 2985 (Admission and Coding Information) or

DA Form 4582-R (Inpatient Accountability System) admission record to authorize an
admission, which is prepared by the admitting officer.
(2) Verify eligibility for care.
(3) Collect other information required for preparing medical records

and reports.
(4) Initiate the Inpatient Treatment Record (ITR).
(5) Obtain insurance information.
MD0752 1-2
1-2. IDENTIFICATION FORMS OR AUTHORIZATIONS
a. Identification Forms. The identification of a person seeking care or treatment at

an Army medical treatment facility (MTF) is usually accomplished in the emergency room,
clinic, or dispensary operated by the department of clinics and community health care
services where the patient is first examined. In addition, the admission clerk who
interviews the patient must establish eligibility of the patient. The following forms will
identify the personnel listed below:
(1) DD Form 2A (green) (Identification Card). Military personnel on active duty,

including members of the Reserve components ordered to active duty for more than 30
days. The lettered suffix identifies the military department.
(2) DD Form 2A (green) (Res). Members of the Reserve components not on

active duty and those on active duty or active duty for training for 30 days or less. Written
authorization from appropriate authority is required for those not on active duty (see para
b(1) below).
(3) DD Form 2A (blue) (Ret). Retired members entitled to retirement pay.
(4) Forms issued by appropriate authority for commissioned officers of the

Public Health Service and the National Oceanic and Atmospheric Administration.
(5) DD Form 1173 (Uniformed Services Identification and Privilege Card).

Family members over 10 years of age; totally disabled veterans; foreign military personal;
and certain civilians who are eligible for medical care and other privileges at military
installations and activities.
NOTE: DEERS (Defense Enrollment Eligibility Reporting System) is a

computerized system used to identify individuals authorized care in a
military medical treatment facility. The sponsor is responsible for
insuring that all dependents are enrolled in DEERS. Eligibility checks
on DEERS along with identification cards are used to identify patients
who are eligible and authorized medical care.
b. Authorization. Other personnel are eligible to receive medical care

with authorization from the sponsoring agency.
(1) Form or written authorization from the appropriate authority of the National
Guard, Army Reserve, or Senior Reserve Officers’ Training Corps for members not on
active duty or active duty for training.
(2) Veterans Administration authorization form prior to hospitalization of

veterans, except in an emergency. Authorization will be obtained within 72 hours after
MD0752 1-3
emergency admission. If hospitalization is not authorized, the medical services account
officer will collect from the patient.
(3) CA Form 16 (Request for Examination and/or Treatment) for beneficiaries of

the Office of Workers’ Compensation Program. In an emergency, the form is furnished
within 48 hours after treatment. If an employee is not authorized medical care at the
expense of Federal funds, the medical services account officer will collect from the patient.
(4) Public Health Services authorization signed by appropriate authority for

beneficiaries of that agency other than commissioned officers of the Public Health Service
or National Oceanic and Atmospheric Administration.
(5) Form or written authorization from the Peace Corps or State Department for
Peace Corps volunteers and dependents who are authorized military health care.
(6) DD Form 214 (Armed Forces of United States Report of Transfer or

Discharge). DD Form 256A (Honorable Discharge Certificate), or DD Form 257A
(General Discharge Certificate Issued Under Honorable Conditions) for proof of eligibility
of female personnel formerly of the uniformed services.
(7) Other forms of authorization, such as travel orders and identification

documents, which establish a person’s affiliation with one of the categories of personnel
who are authorized military health care.
c. Army Regulation 40-3. This regulation is maintained in the files of the admission
and disposition office of the patient administration division as a basic document of
information pertaining to eligibility.
1-3. EXPLANATION OF TERMS FOR ADMISSION AND DISPOSITION (AAD)
a. Definition of Admission. Placing a person under treatment or observation in a

medical center or hospital. The date of initial admission is the date on which the patient
was first admitted to an MTF for the current period of uninterrupted hospitalization. The
patient will be provided with room, board, and continuous nursing service in an area of the
hospital where patients normally stay overnight. The Army identifies the following five types
of admissions:
(1) Direct admission. Admission to the reporting medical treatment facility for
the current uninterrupted period of hospitalization.
(2) Direct absent sick admission. Direct Admission Absent Sick is an active
duty Army patient admitted to a nonmilitary (civilian MTF). For example, while on leave, a
MD0752 1-4
military member becomes ill and is hospitalized in his hometown. The admission is
recorded by the MTF administrative responsibility for the Army member.
(3) Transfer admission. The admission from any military MTF at which the
patient was being carried on an inpatient status to another military MTF is a transfer
admission. For example, a patient is transferred from Walter Reed Army Medical Center
to Brooke Army Medical Center.
(4) Carded for record only (CRO). A term which applies to those special cases
for which a medical record is required to be prepared in essentially the same manner as
for an admission, although no admission has actually occurred. An example is a person
who is dead on arrival (DOA) at a hospital.
(5) Newborn admission. The admission of a newborn is deemed to occur at the

time of birth.
b. Definition of Disposition. “Disposition” refers to the act whereby an inpatient

ceases to be carried on the rolls of a U.S. military medical center or hospital. For example,
if the patient is transferred to another U.S. military medical center or hospital, it is called a
disposition.
The types of disposition are:
(1) Returned to duty.
(2) Discharged to home.
(3) Death.
(4) Separation/retirement.
(5) AWOL from hospital over 10 days.
(6) Transferred to another MTF.
NOTE: Additional definitions and/or expanded definitions are in the Glossary.
MD0752 1-5
Section II. ADMISSION PROCESSING
1-4. RESPONSIBILITY
a. Requirements. Three conditions are incorporated into the requirement for

admission to an Army medical treatment facility.
(1) First and foremost, there must be indication that the patient’s
condition warrants hospitalization.
(2) The patient seeking admission must be authorized by current regulations and
directives to receive care.
(3) The type of treatment or care required by the patient must also be authorized
by current regulations and directives.
b. Responsibilities.
(1) Professional. The indication for admission or treatment is a professional

judgment of a medical officer (physician) or dental officer (dentist).
(2) Administrative. The processing of an individual who is admitted or carded

for record only is accomplished in the Admission and Disposition Section, Patient
Accountability Branch, Patient Administration Division. The Admission and Disposition
Section is an administrative office which takes action only in response to the judgment of a
physician or dentist; medical need determines the admission or disposition of a patient.
The processing of an individual who is admitted includes:
(a) Collecting patient information for the preparation of hospital

records and reports.
(b) Receiving and safeguarding Patients’ Trust Funds (PTFs).
(c) Inventorying personal effects and clothing.
(d) Initiating the inpatient treatment record (ITR).
(e) Preparing identification bands.
MD0752 1-6
1-5. SPECIAL ADMISSION PROCEDURES
a. Emergency Admissions. The procedures are somewhat different in an

emergency situation. The procedures include the following:
(1) Sending the patient directly to the ward or treatment area.
(2) Logging in the registered number log book (covered in a later

paragraph).
(3) Obtaining admission data later, but as soon as possible.
b. Disaster Situation Admission. A local standing operating procedure for

disasters is required. Each item required for processing patients is generally in
prenumbered packets for use in disaster processing. The local SOP is followed.
c. Transfer Admission. The procedures for processing transfer admissions

include:
(1) Sending litter patients directly to the ward.
(2) Processing ambulatory patients through the AAD section.
(3) Sending Copy 2 of DA Form 3647 (Inpatient Treatment Record

Cover Sheet) to the patient administration division.
(4) Sending X-rays to the physician or x-ray department as

appropriate.
(5) Sending the inpatient treatment record to the attending physician.
1-6. AAD PERSONNEL/PATIENT RELATIONS
a. Admission Procedure. As stated in the first paragraph of this lesson, the

reception given by professional and administrative personnel when a patient first enters the
hospital strongly influences the patient’s attitude toward the hospital and the medical care
provided.
(1) Admission clerk. One of the first persons that the patient meets is the
admission clerk. The first impression of AAD personnel will involve courtesy, friendliness,
competence, and neatness. You must be aware of these important areas of standards.
MD0752 1-7
(2) Work area. The environmental factors which will influence the attitude of the
patient are neatness of the work area, efficiency of the personnel, and privacy afforded to
the patient as personal data is collected. The waiting area should also be neat,
comfortable, and cheerful.
(3) Patient interview. The admission clerk will interview the patient to obtain
necessary information for completing required admission forms. In conducting this
interview, the admission clerk should be tactful, courteous, professional, and
understanding. Military patients, both active and retired, should be addressed by rank;
civilians by Mrs., Miss, Ms., etc.
b. Patient Inquiries.
(1) The AAD office may act as an information center for patient questions; offer
as much assistance as possible but DO NOT release private medical information.
(2) Always refer the patient to the physician for medical information or
professional opinion. This type of information must NOT be discussed by office personnel.
1-7. ADMISSION AND DISPOSITION (AAD) FORMS AND PROCEDURES
a. Introduction. Local policies dictate the exact procedures used to establish the
need for admission to a hospital. Some hospitals use a partially completed DA Form
2985 (Admission and Coding Information); others use prepackaged packets for
admission; some note for admission in a health record or outpatient treatment record; or
for active duty military patients, a completed DD Form 689 (Individual Sick Slip); still others
use a local authorization form. Whatever the notification system, the admission clerk
processes the patient’s admission in about the same sequence and with the same
procedures and forms. When a patient enters the AAD office, the notification document is
presented to the admitting clerk. The admitting clerk will then ask to see the patient’s
identification card and will check the identification card for eligibility. A DEERS check is
also required.
b. Need for Admission Documents.
(1) DD Form 689 (Individual Sick Slip) (see figure 1-1). The unit commander for
active duty personnel schedules sick call and refers individual service members to the
medical treatment facility providing primary health care for the unit. DD Form 689
(Individual Sick Slip) is used as an informal memorandum that provides a means of
exchanging information between the unit commander and the attending medical/dental
officer. Although “line of duty” is no longer entered on the form, the information provided by
the unit commander and the evaluation by the medical/dental officer provide a basis for
determination of line of duty. The form is normally initiated by the unit commander and
handcarried by the member, but it may be initiated by the attending medical/dental officer
MD0752 1-8
and forwarded to the unit commander when a patient reports directly to the medical
treatment facility in accordance with local procedures or in case of emergency. The form
may be used in lieu of or to supplement other forms of communication, but the unit
commander should be notified promptly of admission or treatment in quarters in order that
appropriate administrative action may be taken. The admission of a patient assigned to
another installation may, therefore, require a telephone call or telegraph message. The
Individual Sick Slip is not a permanent record, and it is destroyed when it accomplishes its
purpose.
Figure 1-1. DD Form 689 (Individual Sick Slip).
(2) DA Form 2985 (Admission and Coding Information). If this form is used to
notify AAD of the need for admission, the medical officer will generally enter the name of
the patient, the reason for admission in the “For Local Use” block, and signature. Other
information on the DA Form 2985 may also be completed by the admitting officer but is
optional.
(3) Other need for admission documents. Regardless of the form used for
notifying AAD of the need for admission, the signature of the admitting officer must be on
the document.
MD0752 1-9
c. Register Number Log (see figure 1-2). Each patient entering a hospital must
have an identification number assigned. A register number log is established to provide a
convenient, and accurate method of identification. Register numbers begin with number 1
for the first patient ever admitted and continue consecutively thereafter without regard to
whether the patient is military or nonmilitary. When a medical treatment facility (MTF) is
assigned automatic data processing (ADP) equipment for inpatient accounting, register
numbers are assigned in accordance with the manual for ADP procedures. After checking
the medical indication for admission (by the medical or dental officer), identification, and
eligibility, the admitting clerk in the Admission and Disposition Section, Patient Accounting
Branch, Patient Administration Division assigns a register number. To obtain a register
number, the clerk enters the patient’s name, grade, social security number, organization,
type of case, and nursing unit in the register number log next to the first unused number in
the log. This register number is assigned to the patient; no other patient will ever receive
this number at that medical facility. Each time a patient is admitted, he receives a different
register number. At the end of the day (2400), a diagonal line is drawn across the register
and the next date is entered.
REGISTER NAME
RANK SSN ORGANIZATION DIS/ INJ WARD
NUMBER LAST FIRST MIDDLE INITIAL
173624
173625
173626
173627
173628
173629
173930
Figure 1-2. Sample register number log.
MD0752 1-10
d. DA Form 2985 (Admission and Coding Information) (see figure 1-3).
(1) Introduction. The admitting clerk next completes the DA Form 2985 using
information from the patient’s identification card and from interviewing the patient.
Figure 1-3. DA Form 2985 (Admission and Coding Information).
(2) General instructions for completing DA Form 2985.
(a) The DA Form 2985 (see figure 1-3) serves as both a patient admission
information form and a coding transcript for keypunching. The “Source of Data” referenced
in these instructions refer to either the information obtained from the patient interview,
patient’s identification card, or patient’s sponsor, etc.
MD0752 1-11
(b) Since the information on the DA Form 2985 is keypunched for input into
a computer generated report, all information and codes must be written neatly and legibly
to avoid errors in keying. Alphabetic codes must be printed as capital block letters; the
codes do not contain lower case letters. The symbol “O,” meaning zero, must always be
written as “Ø”. The alphabetic letters “O,” “S,” “U,” and “Z” must be written as “O,” “S,” “U,”
and “Z”.
1-8. COMPLETING DA FORM 2985 (ADMISSION AND CODING INFORMATION)
Using the patient’s identification card and notes from the patient interview, the
admitting clerk prepares the DA Form 2985. The DA Form 2985 contains basic
information about the patient. This information is used to prepare other administrative and
medical forms and provide data for computer-generated reports.
a. Reporting MTF. Enter the code for your MTF. (See tables 1-1A and 1-1B for
the applicable four-digit code.)
MTF CODE UNIT LOCATION
9ØB1 41st Combat Support Hospital Fort Sam Houston, TX

91B1 21st Evacuation Hospital Fort Hood, TX
92B1 47th Field Hospital Fort Sill, OK
9ØE1 2d Combat Support Hospital Fort Benning, GA
91E1 4th Combat Support Hospital Fort McClellan, AL
9ØF1 16th Combat Support Hospital Fort Riley, KS
91F1 93d Evacuation Hospital Fort Leonard Wood, MO
9ØG1 7th Combat Support Hospital Germany
91G1 31st Combat Support Hospital Germany
92G1 33th Combat Support Hospital Germany
93G1 128th Combat Support Hospital Germany
94G1 67th Evacuation Hospital Germany
95G1 30th Field Hospital Germany
9ØK1 43d Surgical Hospital Korea
9ØL1 8th Combat Support Hospital Ford Ord, CA
9ØM1 47th Combat Support Hospital Fort Lewis, WA
Table 1-1A. TO&E hospital codes.
MD0752 1-12
MTF CODE MTF NAME MTF LOCATION
Ø1Ø1 Tripler AMC Oahu, HI

Ø111 Bassett ACH Ft Wainwright, AK
Ø121 Gorgas ACH Republic of Panama
Ø131 Coco Solo ACH Republic of Panama
Ø211 USACH Shape, Belgium
Ø311 USACH Berlin, GE
Ø321 USACH Bremerhaven, GE
Ø331 USACH Frankfurt, GE
Ø341 USACH Heidelberg, GE
Ø351 USACH Landstuhl, GE
Ø361 USACH Nuernberg, GE
Ø371 USACH Bad Cannstatt, GE
Ø381 USACH Wuerzburg, GE
Ø391 USACH Augsburg, GE
Ø411 USACH Leghorn, Italy
Ø421 USACH Vicenza, Italy
Ø611 121st Evacuation Hospital Seoul, Korea
1ØØ1 Walter Reed AMC WASH DC
1111 Patterson ACH Fort Monmouth, NJ
1121 Keller ACH West Point, NY
12Ø1 Fitzsimons AMC Denver, CO
1211 USACH Fort Carson, Co
1221 Munson ACH Fort Leavenworth, KS
1231 Fort Leonard Wood ACH Fort Leonard Wood, MO
1241 Irwin, ACH Fort Riley, KS
1251 USACH Fort Sheridan, IL
1261 Prov Res Hospital Fort McCoy, WI
13Ø1 Eisenhower AMC Fort Gordon, GA
1311 Martin ACH Fort Benning, GA
1321 Blanchfield ACH Fort Campbell, KY
1331 Moncrief ACH Fort Jackson, SC
1341 Nobel ACH Fort McClellan, AL
1351 Fox ACH Redstone Arsenal, AL
1361 Lyster ACH Fort Rucker, AL
1371 USACH Fort Stewart, GA
14Ø1 Brooke AMC Fort Sam Houston, TX
Table 1-1B. MTF codes
MD0752 1-13
b. MTF Location. Enter your MTF’s state location code.
c. Register Number. Enter the number assigned from the Composite Health
Care System (CHCS). Nonautomated hospitals should enter the register number from the
Register Log Book for each admission.
(1) MTFs assign a register number to each admission, birth, or CRO regardless
of whether the patient is military or nonmilitary.
(2) The register number series begins with number 1 when the hospital is
activated and continues consecutively until the hospital is deactivated.
d. Name. Enter the patient’s name (last, first, middle initial).
e. Grade. Enter from admission interview/identification card. See table 1-2.
ARMY MARINES NAVY/COAST AIR FORCE DATA CODES

GUARD
BRIGADIER BRIGADIER COMMODORE BRIGADIER G1
GENERAL (BG) GENERAL (Commodore) GENERAL
(Brig Gen) (Brig Gen)
FIRST FIRST LIEUTENANT, FIRST 02
LIEUTENANT LIEUTENANT JUNIOR GRADE LIEUTENANT
(1LT) (1st Lt) (LTJG) (1st Lt)
MASTER MASTER E8
SERGEANT SERGEANT - -
(MSG) (MSGT)
PRIVATE FIRST LANCE SEAMAN AIRMAN FIRST E3
CLASS (PFC) CORPORAL (LCpl) (Seaman) CLASS (A1C)
Table 1-2. Sample of authorized grade abbreviations and data codes.
(1) Record grade on date of admission for active duty and retired military.
(2) Use the abbreviations authorized in AR 310-50 for military members of all
components, including retirees of U.S. and foreign military services. Examples: PVT, SFC,
1LT, COL, etc. For all other nonmilitary patients, leave this field blank.
f. Sex. Enter “F” for female and “M” for male, or “Z” for unknown. The MTF must
make a choice in uncertain cases as in extreme deterioration of remains in which a
pathologist cannot make a determination.
g. Date of Birth. Enter in succession, four digits for year of birth; two digits for
birth month; and two digits for day of birth.
MD0752 1-14
h. Age. Enter the age as described below:
(1) Live births at you MTF and transferred live births less than 24 hrs old, enter
00D.
(2) Enter patient’s age in completed days, months, or years at the time of this
admission to your MTF. For infants under 1 month old, enter the age in days; for example,
“02D” or “22D”. For a child 1 month but less than 12 months old, enter the age in
completed months; for example, “02M” for a child who is 2 months and 25 days old. For a
child 12 months but less than 24 months, enter “01Y” (1 year).
(3) If the patient is 1 year old or older, enter the age in completed years. Zero fill
to the left to make a two digit code for patients 1-9 years of age. The code 99Y will be
used for patients 99 years old and older.
i. Race. Enter the race determined during the interview according to table 1-3.
Do not use (Z) for U.S. active duty personnel, Reserve and National Guard, or service
Academy Cadets.
DATA ITEM ABBREVIATION
American Indian/Alaskan Native AAN
Asian Pacific Islander API
Black, Not of Hispanic Origin BNH
Black, Hispanic Origin BHO
White, Not of Hispanic Origin WNH
White, Hispanic Origin WHO
Unknown UNK
Table 1-3. Race codes
MD0752 1-15
j. Ethnic background. Enter the appropriate data code and abbreviation from
table 1-4. This field is a required field for all patients. The Z (unknown) is acceptable for all
patients except for AD personnel.
Description Abbreviation Data Code
Hispanic Hisp 1
SE Asian Se Asi 2
Filipino Filip 3
Asian Pacific Islander Oth A/P 4
Other Oth 5
Unknown Ukn Z
Table 1-4. Ethnic Background.
k. Religion. Enter the abbreviation for the patient’s religious preference (see table
1-5). Leave blank for CRO cases.
DATA ITEMS AND DEFINITIONS ABBREVIATION
No religious preference, Same as “None.” NO-REL-PREF

Adventist, Seventh Day ADV-SEV-DAY
Baptist-Southern Baptist Convention SO-BAPT
Buddhism BUD
Disciples of Christ DIS-CHR
Friends FRIENDS
Quaker
Jewish JEWISH
Lutheran (excludes Lutheran, Missouri Synod) LUTH
Lutheran, Missouri Synod LUTH-MO
Methodist (includes Evangelical United Brethren) METH
Muslim MUSLIM
Roman Catholic ROMAN-CATH
Protestant-Other Churches PROT-OTHER
Unknown UNK
Table 1-5. Sample of authorized religion abbreviations.
MD0752 1-16
l. Length of Service. For U.S. Uniformed Services personnel, foreign military
personnel, and cadets of the U.S. Uniformed Service academies, enter total length of all
AD service as of this admission (see table 1-6).
Data Item and Explanation Data Code
Entry to AD to 30 days 00D-30D

One month, less than 12 01M-11M
Twelve months to 40 years 01Y-40Y
Unknown ZZZ
Table 1-6. Length of Service.
(1) Less than 1 month record in days such as “12days,” data code 12D.
(2) Less than 1 year record in months using completed months such as
“11months, ” data code 11M.
(3) From 1 year to 40 years record in years using completed years such as “18
years” for service of 18 years and 9 months, data code 18Y.
(4) If days, months, years of service are less than 10, enter a “0” in the first
position. This is a required field for AD. For all other patients, leave blank.
Do not use unknown (ZZZ) for AD Army, Navy, Air Force, Marine Corps or Reserve
and National Guard personnel or for Service Academy Cadets.
m. Expiration of term of service (ETS).
(1) Enter that date of ETS for all active duty personnel.
(2) For family members enter date of expiration of identification card, DD Form
1173.
(3) For all other patients, leave blank.
n. Family Member Prefix (FMP). The AAD office will determine the correct code
from the interview (see table 1-7).
MD0752 1-17
Children (Oldest, Next Oldest, Etc.) Ø1-19
Sponsor (Prime Beneficiary) 2Ø
Spouse of Sponsor 3Ø
Mother or Stepmother of Sponsor 4Ø
Father or Stepfather of Sponsor 45
Mother-in-Law of Sponsor 5Ø
Father-in-Law of Sponsor 55
Other Bonafide Dependents 60-69
Civilian Emergencies ØØ
Stillborns Carded for Record Only (CRO) 99
Table 1-7. Family member prefix.
o. Social Security Number (SSN). Enter the SSN of the sponsor (AD, retired
member, deceased member, member of reserve components, or prime beneficiary).
p. Organization. Enter military patient’s unit of assignment at the time of initial

admission or CRO.
q. Marital status. Enter the appropriate marital status data code from table 1-8.
This is a required field for all patients.
Description Abbreviation Data Code
Annulled Ann A
Divorced Div D
Interlocutory Inter I
Legally Separated Sep L
Married Marr M
Single, never Married Sing S
Widowed Wid W
Unknown Unk Z
Table 1-8. Marital Status
r. Hour of admission. Using the 2400 system, enter time patient is admitted. For
newborn, infants, enter the time of birth.
s. Branch/Corps. Enter branch for enlisted personnel and other service officers
and corps for active or retired Army officers. For all others leave blank.
MD0752 1-18
t. Flying status. For those military patients on flying status, code “Y” for yes and
“N” for no. For all other patients leave blank.
u. Beneficiary category. For U.S. Uniformed Services personnel (active or

retired), enter the applicable category (see table 1-9).
MILITARY
Extended AD:
Army A11
Navy N11
Marine Corps M11
Air Force F11
Coast Guard C11
U. S. Public Health Service P11
National Oceanic and Atmospheric Administration B11
Retirees:
Length of Service:
Army A31
Navy N31
Marine Corps M31
Air Force F31
Coast Guard C31
Family Members:
Family Members of AD Uniformed Services Personnel

(Excludes Former Spouse)
Army A41
Navy N41
Marine Corps M41
Air Force F41
Coast Guard C41
Table 1-9. Department/Type of Beneficiary (continued).
MD0752 1-19
Family Members of Retired U. S. Uniformed Services Personnel

(Excludes Former Spouse)
Army A43
Navy N43
Marine Corps M43
Air Force F43
Coast Guard C43
U. S. Civilian Employees/Family Members:
State Department Employee-Overseas K51

State Department Family Member – Overseas K52
Other Federal Agencies/Depts Employee K53
Other Federal Agencies/Depts Family Members K54
DoD Remote Area Employee-CONUS K55
DoD Remote Area Family Member-CONUS K56
DoD Occupational Health K57
Disability Retirement Exam K58
Other K59
Foreign Nationals/Family Members
IMET/SALES K71
NATO Military K72
NATO Family Member K73
Non-NATO Military K74
Non-NATO Family Member K75
Foreign Civilian K76
Foreign Civilian Family Member K77
Prisoner of War/Internees K78
Other K79
Table 1-9. Department/Type of Beneficiary (concluded)
MD0752 1-20
(1) For civilian employees of Federal agencies, indicate the Federal
department (i.e., Army, Navy, State, Education, Health and Human Services, Justice,
Commerce, Labor, Treasury).
(2) For foreign military personnel, indicate the nation and armed forces with
which the patient is serving such as Federal Republic of Germany, Army.
v. Zip code of residence. For CONUS, Alaska and Hawaii, enter the nine-digit zip
code of the patient’s residence. If the last four are unknown, zero-fill these positions. This
field is required for all patients.
w. Military Occupational Specialty (MOS) code. Enter the MOS for the AD
patient. This field is left justified; do not zero-fill. This is a required field for U.S. AD,
Reserve, and National Guard personnel.
x. Previous admission. Enter year of previous admission if patient had been

admitted to your MTF whether for the same or for any other condition. If no previous
admission, check, “No”.
y. Source of admission/authority. Include authority for admission paragraphs

from AR 40-3 in this block, see table 1-10.
Direct to military hospital from ER 0

Direct to military hospital from other than ER 1
AD direct to non-U.S. Armed Services hospital never
Transferred to military hospital 3
Initial admission in non-U. S. Armed Services hospital,
Transferred to military (AD only) 4
Initial admission in non-U. S. Armed Services hospital,
(non-AD only) 5
Transfer from U. S. Army hospital 6
Transfer from U. S. Navy hospital 7
Transfer from U. S. Air Force hospital 8
Live birth in this hospital L
CRO C
Table 1-10. Source of Admission
MD0752 1-21
(1) Enter “Dir” for direct admission from other than Emergency Room (ER).
(2) Enter “Dir-ER” for direct admission from the ER.
(3) Enter “Trnsf” when the patient has been transferred from any other facility.
(4) Enter ‘CRO” for carded for record only cases.
(5) Enter “NB” for live-born infant born at your MFT.
z. Ward. Enter the ward/nursing unit to which the patient is admitted. Leave blank
for CRO.
(1) Enter “Abs SK” for AD patients whose entire period of hospitalization is in a
non U.S. Armed Services MTF and have never transferred to a military MTF.
aa. Name/ relationship, address, and telephone number of emergency

addressee. Enter information relating to the emergency addressee. Leave blank for
CRO.
bb. Name and location of MTF. Enter the name and location of the reporting
MTF.
MD0752 1-22
Medical Expense and Performance Reporting System (MEPRS)
Clinic Service
Clinic Service Abbreviation Data Code
Adolescent Pediatrics Adol Ped ADDA

Allergy Algy AASA
Bone Marrow Transplant Marr Trans AAQA
Cardiology Cardio AABA
Cardiovascular/Thoracic Surgery Cv/Thor Surg ABBA
Clinical Immunology Cl Immu AAOA
Coronary Care Unit (CCU) CCU AACA
Dermatology Derm AADA
Endocrinology Endocrin AECA
Gastroenterology Gastro ABPA
General Surgery Gen Surg ABAA
Gynecology GYN ACAA
Hand Surgery Hand Surg AECA
Head and Neck Surgery Hd/Nk Surg ABPA
Hematology Hem AAGA
Human Immunodeficiency Virus
(HIV) III, Acquired Immune
Deficiency Syndrome (AIDS)
Referral Center HIV AAPA
Infectious Disease Inf Dis AARA
Institute of Surgical Research
(Burn Center, Brooke Army
Medical Center (BAMC) only)) ISR ABMA
Internal Medicine Int Med AAAA
Medical Intensive Care Unit (MICU) MICU AAHA
Neonatal Intensive Care Unit (NICU) NICU ADCA
Nephrology Nephro AAIA
Neurology Neuro AAJA
Neurosurgery Neuro Surg ABDA
Nursery Nsy ADBA
Obstetrics OB ACBA
Oncology Oncol AAKA
Ophthalmology Ophth ABEA
Oral Surgery Oral Surg ABFA
Organ Transplant, Walter Reed
Army Medical Center (WRAMC) Org Trans ABLA
Orthopedics Ortho AEAA
Otorhinolaryngology ENT ABGA
Pediatrics Ped ADAA
Pediatric Surgery Ped Surg ABHA
Table 1-11. MEPRS Clinic Service (continued).
MD0752 1-23
Medical Expense and Performance Reporting System (MEPRS)
Clinic Service
Clinic Service Abbreviation Data Code
Peripheral Vascular Surgery Pv Surg ABNA

Physical Medicine Phys Med AANA
Plastic Surgery Plas Surg ABIA
Podiatry Pod AEBA
Proctology Procto ABJA
Psychiatry Psy AFAA
Pulmonary/Upper Respiratory
Disease Pulm Dis AALA
Rheumatology Rheum AAMA
Substance Abuse Rehabilitation SA Rehab AFBA
Surgical Intensive Care Unit (SICU) SICU ABCA
Trauma Center Trau Ctr ABOA
Urology Urol ABKA
FAMILY PRACTICE (FP)
FP Gynecology FP GYN AGEA

FP Medicine FP Med AGAA
FP Nursery FP Nsy AGHA
FP Obstetrics FP OB AGCA
FP Orthopedics FP Ortho AGGA
FP Pediatrics FP Ped AGDA
FP Psychiatry FP Psy AGFA
FP Surgery FP Surg AGBA
CARDED FOR RECORD ONLY CRO XXXA

Absent Sick Abs Sk YYYA
Table 1-11. MEPRS Clinic Service (concluded).
cc. Clinic service admitting. Designated by physician. Enter the initial clinic
service patient is assigned to upon admission (see table 1-11).
dd. Date of this admission. Enter date of the actual admission to your MTF.
(1) Enter the date of notification or preparation of record for CRO cases.
MD0752 1-24
(2) Enter the date the AD patient is received in your MTF from the civilian facility
for absent sick cases.
(3) Enter the date of birth for newborn infants in your MTF.
ee. For Local Use. The MTF will locally determine entries made in this block. In
injury cases, how, when and where injury occurred is entered here.
ff. Admitting Officer. Enter the name of the physician or other provider authorizing
admission. If the DA Form 2985 is used as the admission authorization, the admitting
officer will sign in this block.
gg. Signature of Admitting clerk. The admitting clerk will sign in this block.
1-9. THE NINE-LINE PLATE
a. Use of DA Form 2985 (Admission and Coding Information). The information

on the DA Form 2985 is keypunched and used for a number of computer-generated
reports. However, in the AAD office, it is initially used to make up the nine-line plate
discussed in the next two paragraphs. Some of the information on DA Form 2985 is not
used on the nine-line plate and will be taught in a later lesson. Some of the information on
the coding form is not written into the computer coding boxes (small boxes) on the form but
is entered into the space beside the small computer coding boxes at the time of
admission. Computer coding is done later. Computer coding is taught in a later
subcourse.
b. Embossed Identification Plates. These plates are prepared by hospitals

having addressograph embossing equipment for mechanical record writing. This system
is authorized in fixed Army hospitals where the volume of admissions and dispositions
warrants procurement of the necessary equipment. An MTF without such equipment will
initiate the necessary forms with typewritten entries. Hospitals having automatic data
processing equipment may adopt appropriate portions of the mechanical writing system
which are not accomplished through automatic data processing. After preparing DA Form
2985, the admitting clerk will use the embossing machine to prepare the nine-line plate.
The embossing machines will produce either a metal plate or a plastic plate similar to
credit cards.
c. Preparation of the Nine-Line Plate. The admitting clerk prepares the nine-line
plate using DA Form 2985 as the source of information.
d. Sample Nine-Line Plate. Figure 1-4 is a sample embossed nine-line plate.

The figure illustrates the plate and reviews the information which goes onto the plate.
MD0752 1-25
746932 BERRY THOMAS K MSG
M 39 WNH JEWISH 15 21 MAY 88 82
20 38053 44 59 HG FT SAM HOUSTON 83
ARMY 78234
DIR PARA 4-1 AR 40-3 1415 TM1
MRS L B BERRY/W
7238 ESTATE FT SAM HOUSTON TX 822-3183/
BAMC FT SAM HOUSTON TX 78234
/6 JULY 83
LINE 1 = Register Number, Name, Grade

LINE 2 = Sex, Age, Race, Religion, Length of Service, ETS, Previous Admission
LINE 3 = FMP, SSN, Organization, Ward.
LINE 4 = Beneficiary Category, Unit Identification Code/Zip Code, Type of Case
LINE 5 = Source of Admission, Hour of Admission, Clinic Service
LINE 6 = Name/Relationship of Emergency Addressee
LINE 7 = Address of Emergency Addressee, Telephone, Date of Admission
LINE 8 = Name and Location of MTF
LINE 9 = Continuation of Line 7 (Indicated by /)
Figure 1-4. Sample nine-line addressograph plate (patient data card).
e. Other Embossed Plates. The admitting clerk will then prepare additional plates
for use with other clinical records.
(1) One of the additional plates is the inpatient identification plate. It

contains the name, grade, register number, family member prefix and social security
number, sex, and age.
(2) Another embossed plate is the nursing unit or clinic identification plate. It
contains the name and location of the MTF and the identification of the nursing unit, clinic,
or other functional area. The inpatient identification and nursing unit identification plate
may be combined into one plate or both used together to imprint information on clinical
record forms. Figure 1-5 contains sample plates and identifies the format in which the data
is entered.
MD0752 1-26
Figure 1-5. Sample embossed nursing unit or clinic identification plate,
inpatient identification plate, and patient recording card.
1-10. WRIST IDENTIFICATION BAND
The wrist identification band is prepared for each patient to show the name and
register number. Local procedures are followed in determining whether the band is place
on the wrist (either wrist) of the patient before or after arrival on the nursing unit. Figure 1-6
shows a sample wrist identification band. You must use a waterproof pen or waterproof ink
for the wrist identification band.
MD0752 1-27
Figure 1-6. Sample wrist identification band.
1-11. OTHER FORMS
a. DA Form 3696 (Patient’s Deposit Record). The deposit record is initiated by

imprinting with the nine-line plate (admitting plate). An original and a copy are prepared
and signed by the custodian (under funds or valuables for deposit) and by the patient
(upper-right block with the word “not” deleted) if the patient wishes to deposit funds and
valuables. The original is sent to the Patients’ Trust Fund (covered in another lesson) and
the copy is retained y the patient. If the patient has no deposits, only an original is
prepared for the custodian and is signed by the patient in the upper-right corner to indicate
that no deposit is to be made. The admitting clerk should inform the patient that the
hospital will not assume liability or responsibility for loss of funds and valuables which are
retained in the patient’s possession. When the patient wishes to make a deposit, the
patient takes both copies of DA Form 3696 to the Patients’ Trust Fund. The Patients’ Trust
Fund personnel and receipt for funds and valuables by signing the DA Form 3696. The
patient is given one signed copy. The deposit record has spaces for withdrawals and
deposits during the patient’s stay in the hospital. See figure 1-7.
MD0752 1-28
Figure 1-7. DA Form 3696 (Patient’s Deposit Record).
MD0752 1-29
b. DA Form 3153 (MSA Patient Ledger Card). The Patient Ledger Card (see
figure 1-8) is imprinted with the admitting plate and is used to account for charges and to
bill patients who pay portions of their care, treatment, or subsistence. Normally, every
patient, except retired enlisted personnel and newborns with their mother, pay some
portion of the charges.
Figure 1-8. DA Form 3153 (MSA Patient Ledger Card).
MD0752 1-30
c. DA Form 3647-1 (Inpatient Treatment Record Cover Sheet). The Inpatient
Treatment Record Cover Sheet is prepared as an original and three copies for each
patient admitted and for each case carded for record only. The DA Form 3647-1 is
imprinted on a four-part set with the admitting plate; the DA Form 3647 is prepared with a
typewriter. The information source for this form is the DA Form 2985 (Admission and
Coding Information). See figure 1-9.
Figure 1-9. DA Form 3647-1 (Inpatient Treatment Record Cover Sheet).
MD0752 1-31
d. DA Form 4029 (Patient’s Clearance Record). See figure 1-10. The Patient’s
Clearance Record is imprinted with the admitting plate and held for use in clearing the
patient at the time of disposition. Preparation of this form at the time of admission is
optional.
Figure 1-10. DA Form 4029 (Patient’s Clearance Record).
MD0752 1-32
e. DA Form 3444 Series (Treatment Record). See figure 1-11. This multipurpose
folder is used to file inpatient treatment record forms for each patient. The patient’s
identification is imprinted from the admitting plate. The terminal digit filing system
procedures you studied in Subcourse 751 apply to the inpatient treatment record. Rather
than imprinting from the admitting plate, local procedure may require a label be prepared
from the patient recording card (PRC).
Figure 1-11. DA Form 3444 Series (Treatment Record).
MD0752 1-33
f. Optional Forms. Local procedures may require that additional forms be
prepared for each patient admitted. One example of an optional form is DA Form 4160
(Patient’s Personal Effects and Clothing Record).
g. Bed Card (see figure 1-12). A 3-inch by 5-inch card is prepared on a bulletin-
type (large type) typewriter or is handprinted to show each inpatient’s name, grade or
status, uniformed service, and date of admission. This card is placed in a card holder at
the foot of the patient’s bed.
THOMAS K. BERRY
MSG
ARMY
6 JULY 88
Figure 1-12. Sample bed card.
1-12. SUMMARY
At this point, the admitting clerk has completed the required paperwork and the
patient is ready to proceed to the ward. The clerk pulls the last copy of DA Form 3647 and
sends it to the ward with the patient. Other forms may also be sent with the patient to the
ward such as the bed card, the inpatient identification card, and DA Form 4029. For active
duty patients, the admitting clerk notifies the unit commander or his representative. The
nine-line plate or a 3-inch by 5-inch card prepared from the nine-line plate (called a patient
data card (PDC)) is filed in the AAD file for use in preparing the AAD report the next
morning (any time after 2400 hours). The AAD report is discussed in the next section of
this lesson. Briefly stated, the steps in admission are:
a. Check the need for admission.
b. Check the identification card and patient eligibility.
c. Assign a register number.
d. Complete DA Form 2985, (Admission and Coding Information Form).
MD0752 1-34
e. Prepare the nine-line plate and/or identification plates. You may be required to
prepare several 3-inch by 5-inch cards for each admission. These cards may be
distributed to the mailroom, food service, chaplain, pharmacy, and Red Cross in
accordance with local policy.
f. Initiate required inpatient forms such as DA Form 3696, DA Form 3647, DA Form
3153, DA Form 3444, etc.
g. Prepare the wrist identification band.
h. Prepare the bed card.
i. Notify the unit commander or his representative for active duty personnel.
j. Send the patient to the ward with the appropriate forms (determined by local
procedures).
k. File the nine-line plate or patient data card used for the AAD report.
Section III. SPECIAL REPORTING REQUIREMENTS
1-13. REPORTS TO U.S. ARMY MEDICAL COMMAND (MEDCOM)
Medical treatment facilities will notify the MEDCOM of the admission, changes in
condition (such as major improvement or worsening of condition, including seriously ill/very
seriously ill changes), and dispositions of persons in the categories shown below.
Information is telephoned to MEDCOM within four hours of occurrence or as soon
thereafter as possible with inclusion of data listed in paragraph b below.
a. Categories to be Reported.
(1) The President of the United States and Family Members.
(2) The Vice President of the United States and Family Members.
(3) Former Presidents of the United States and Family Members.
(4) Cabinet members.
(5) US Supreme Court Justices.
(6) Members of Congress
MD0752 1-35
(7) Secretaries of Defense, Army, Navy, and Air Force.
(8) U.S. Army Medical Command subordinate commanders.
(9) Foreign heads of state.
(10) Foreign dignitaries.
(11) Nationally known figures or celebrities and their family members who, in the
opinion of the MTF commander, could be expected to be of particular interest to the
Commanding General, U. S. Army Medical Command or the news media.
(12) Any military member assigned to a U.S. Army Medical Command activity
upon notification of his/her death.
(13) The admission and disposition of General officers.
b. Information to be Provided.
Admission Disposition
(1) Full name of patient. Same.
(2) Grade/position/status. Same.
(3) Social security number, if applicable. Same.
(4) Unit, if applicable. Same.
(5) Medical treatment facility to which admitted. Same.
(6) Date admitted. Same.
(7) Brief medical diagnosis in nontechnical Final diagnosis and

language to include a brief description of injury, if condition upon
applicable, overall condition, and changes thereto, completion of
as applicable. hospitalization.
(8) Prognosis and anticipated length of hospi- Nature of disposition;

talization and changes thereto, as applicable. duty, discharge, death,
or transfer to (name
and address of MTF),
as applicable.
MD0752 1-36
1-14. INJURY CASES
a. The Government is required by law in certain cases to recover from third persons
the reasonable costs of hospital, medical, surgical, or dental care required by an individual
who is injured under circumstances creating a tort liability upon some third person. This
provision does not apply to battle casualties nor to care provided in a facility of another
uniformed service or department or agency of the United States for an individual whose
medical care is a responsibility of the Department of the Army.
b. The Recovery Judge Advocate (RJA) is the judge advocate who assumes
responsibility for the health care recovery program in the geographic area in which initial
treatment or hospitalization is provided for an injured person who is entitled to health care
at Army expense.
c. The original DA Form 2985 (Admission and Coding Form) is used to notify the
RJA of injury-type patients admitted to an Army medical treatment facility. The block “For
Local Use” on the form is used for information on diagnosis and all available accident
information (how, where, when, or doing what). The DA Form 2985 is forwarded to the
RJA for screening and determining whether or not a possible third party tort case exists.
Third party liability is covered in Subcourse 755, Patient Affairs Branch. Further action will
depend upon the type of determination made and noted by the RJA on the DA Form 2985
when it is returned to the medical treatment facility. The information in this block is also
used to make the line of duty determination. Line of duty (LD) determination refers to
findings under rules for determining whether a disease or injury was incurred while the
individual was properly fulfilling a role as a member of the Army or other uniformed service.
LD is also covered in Subcourse 755.
Section IV. ADMISSION AND DISPOSITION REPORT
1-15. GENERAL
a. An Admission and Disposition (AAD) Report reflecting gains, losses, and other
changes in patient status is prepared by each hospital for each calendar day it is in
operation.
b. Each day, the report is prepared by 2400 hours. The report includes data from
the first and third lines of the admitting plate and the type of case from the fourth line. When
preparing the AAD Report, admitting plates on those patients affected by any transaction
in table 1-12 are filed behind the appropriate headers of the AAD file.
c. The heading on the AAD Report includes the date and serial number. The serial
number consists of the Julian date and the last two digits of the year. (The Julian date is
indicated on each page of all standard Government calendars.) For example, the serial
number for the AAD Report for 1 January 198X would be 001-8X while the serial number
MD0752 1-37
for the AAD Report for 6 July 198X would be 188-8X. When the designation of the hospital
does not include the term “U. S. Army,” it is added parenthetically. (For example, 10th
Combat Support Hospital (U.S. Army) and Brooke Army Medical Center ) (U.S. Army)).
d. The AAD Report contains entries pertaining to each patient affected by

transactions listed in table 1-12. Entries are grouped according to type of transactions.
Each group is identified by a heading as shown in table 1-12. Within each type of
transaction group, further subgroups by beneficiary category, organization, or other status
is made. Listing of individuals within the groups or subgroups are in the sequence the local
MTF desires; that is, alphabetical, by grade, by time of admission, and so on. Additional
information, such as diagnosis or circumstances of wounds or injuries, may be added,
provided the information is kept confidential and entries required by regulation appear first
and in the proper sequence.
e. The AAD Report may be prepared manually or by computer, depending on

the local procedure. Regardless of what method is used, the format and sequence
prescribed in AR 40-400 must be used by each MTF.
f. The AAD Report is authenticated by the patient administrator or by another

designated individual.
MD0752 1-38
Table 2-1
AAD Report headings—Continued
Heading Transaction involved
1. Gains (Admissions) a. Direct admission to hospital.

b. Direct admission, absent sick.
c. Transfer admission.
d. Newborn.
2. Change of status in a. From leave.

b. From subsisting out.
c. From AWOL (less than 10 days)
d. From absent sick in nonmilitary MTF.
e. From temporary duty(TDY) or special duty
(SDY)
f. From supplemental care.
g. From cooperative care.
h. From the medical holding unit.
3. Losses (dispositions) a. Returned to duty.

b. Separated form service.
c. Retired-length of service.
d. Retired-Permanent Disability Retired List.
e. Retired-Temporary Disability Retired List.
f. AWOL over 10 days.
g. Discharged form hospital. (Use only for
nonmilitary personnel..)
(1) Newborns.
(2) All other nonmilitary patients.
h. Died.
(1) Newborns.
(2) All other.
i. Transferred. (Show facility to which
transferred-used appropriate header
plates.)
(1) Newborns.
(2) All others.
4. Change of status out a. To leave.

b. To subsisting out.
c. To AWOL.
d. To absent sick in nonmilitary MTF.
e. To TDY/SDY
f. To permanent change of station (PCS):
home or Veterans Administration (VA)
hospital.
g. From absent sick to leave.
h. To supplemental care.
i. To cooperative care.
j. To the medical holding unit.
Table 1-12. AAD report headings (continued).
MD0752 1-39
Table 2-1
AAD Report headings -- Continued
Heading Transaction involved
5. Other transactions a. Interward transfers.

b. CRO
c. Passes in excess of 24 hours.
(1) "To" pass.
(2) "From" pass.
d. From newborn to pay patient.
e. Transient patients (numbers of).
(1) Remaining from previous days
(2) Arriving.
(3) Departing.
(4) Remaining.
f. Boarders (numbers of)
(1) Remaining from previous days.
(2) Arriving.
(3) Departing.
(4) Remaining.
g. Corrections of prior AAD Reports.
6. Separate foreign nation listings

See figure 2-1 for sample of separate listings
required for NATO patients.
7. Recapitulation
Table 1-12. AAD report headings (concluded).
g. A recapitulation table is added at the end of each report. The table includes,
but is not limited to, data on the number of patients that are:
(1) Remaining from the previous day.
(2) Admissions.
(3) Dispositions.
(4) Remaining as of this report.
(5) Absent (includes absent without leave (AWOL)).
(6) On leave.
(7) Subsisting out.
MD0752 1-40
(8) Occupying beds.
(9) Newborn.
1-16. FILES
Two basic files, the AAD file and the control file, are used to prepare the AAD
report.
a. AAD File. This file contains the admitting plate units (or 3-inch by 5-inch cards)
of all patients for whom an entry on the report is required for the current day. Every patient
having activity has an entry on the report. Header plates or cards to identify the sections on
the report are in this file.
b. Control File. This file contains the admitting plates (or 3-inch by 5-inch cards)
of all patients on the rolls of the MTF but who are not included in the AAD file. The
arrangement of the file is established by local procedure but it must contain a “hold” section
for the admitting plates (or cards) of patients who are carried in a “change of status out”
category. This category is defined in later paragraphs.
c. Use. The files are used to reflect the activity occurring in an MTF. For
admission, the admitting plate or patient data card (PDC) is filed in the AAD file behind the
appropriate header card. Header cards are explained in the following paragraph. As
other transactions (activities) occur, such as change in status, disposition, interward
transfers, etc., the patient’s admitting plate (or PDC) is pulled from the control file and
placed behind the appropriate header card in the AAD File. Once the AAD report is
prepared, the file is cleared. This means that for patients remaining on the rolls, the
admitting plate (or PDC) is returned to the control file. For those patients who have been
dispositioned, the admitting plate (or PDC) is disposed of in accordance with local
procedures.
1-17. AAD REPORT HEADINGS
The AAD report has five major headings. Each major heading has subheadings
which identify the transaction (activity) more specifically. Each of these headings has
specific meaning. Each is defined in the following paragraphs. The types of transactions
are listed in table 1-12. A header card and subheader card are prepared for each.
a. Gains (Admissions). The act of placing an individual under treatment or

observation in a medical center or hospital. The day of admission is the day on which the
medical center or hospital makes a formal acceptance of the patient who is to be provided
with room, board, and continuous nursing service in an area of the hospital where patients
normally stay at least overnight. The admission of newborn is deemed to occur at the time
of birth.
MD0752 1-41
(1) Direct admission to hospital. Admission for the first time to an MTF for
current (continuous) hospitalization.
(2) Direct admission absent sick. An Army member being accounted for in an
absent sick status is a direct admission to the MTF having administrative responsibility.
Absent sick is an active duty Army patient admitted to a nonmilitary (civilian) MTF.
(3) Transfer admission. For active duty military members, the admission from
any military MTF at which the patient was being carried on the inpatient status. Active duty
Army members initially hospitalized in a civilian MTF and carried as absent sick by some
Army MTF would be a transfer admission when transferred to inpatient status at another
Army MTF. The CR will reflect the uninterrupted period of hospitalization and any in transit
days will be documented. Active duty Army members on absent sick status who are
brought into the reporting MTF are “change of status in” from absent sick, not transfer
admissions. For civilian/dependent personnel, admission by transfer applies only when a
transfer admission takes place between two U. S. military MTFs. In other cases,
civilian/dependent personnel are considered to be direct admissions.
(4) Newborn. All live births.
b. Change of Status In. Refers to the return of an absent patient or the arrival of
an absent sick status patient.
NOTE: The definitions for the transactions within the “change of status in” are provided in
the “change of status out.”
(1) From leave (see para d(1)).
(2) From subsisting out (see para d(2)).
(3) From AWOL (less than 11 days ) (see para d(3)).
(4) From absent sick in nonmilitary MTF (see para d(4)).
(5) From TDY/SDY (see para d(5)).
(6) From supplemental care (see para d(8)).
(7) From cooperative care (see para d (9)).
(8) From the medical holding unit (see Glossary for definition).
MD0752 1-42
c. Losses (Dispositions). As explained earlier, the term “disposition” refers to
the act whereby the U. S. military medical center or hospital gives over the care of the
patient through discharge, death, separation/ retirement, or other termination of inpatient
status. This includes transfer of the patient to another U. S. military medical center or
hospital or any release of a patient who is not expected to return. The day of discharge is
the day on which the medical center or hospital formally terminates the period of inpatient
hospitalization.
(1) Returned to duty. An active duty returned to normal duty.
(2) Separation from service. An active duty patient separation from the military
with less than 20 years of service for other than disability reasons.
(3) Retired (length of service). An active duty patient retired from the military
after 20 or more years for nondisability reasons or for disability less then 30 percent.
(4) Retired (permanent disability retired list--PDRL).

Retirement of a member whose disability is permanent is placed on the PDRL, regardless
of whether they have 20 or more years of active duty service.
(5) Retired (temporary disability retired list--TDRL). A member placed on this

list is required to undergo a physical examination not less frequently than every 18 months
during a period not to exceed five years from the date placed on the list. The examination
is for the purpose of evaluating the members condition to determine whether he is fit for
return to active duty, should be continued on TDRL (if within the 5-year period), or be
transferred to the permanent disability retirement list. At the end of five years, the member
will be given the choice of returning to active duty or being separated from the service or
placed on the permanent disability retired list. Such action will be taken sooner if the
member’s condition stabilizes to a degree to permit final disposition.
(6) AWOL over 10 days. A member gone past midnight of the tenth day is
dropped from the rolls. If the member returns after the tenth day, a new admission is made.
NOTE: Transactions (1) through (6) above apply to active duty personnel only .
(7) Discharged from hospital (use only for other than active duty military
personnel). A patient is released from the hospital and is not expected to return.
(a) Newborns.
(b) All other nonmilitary patients.
MD0752 1-43
(8) Died. Self-explanatory.
(a) Newborns.
(b) All others.
(9) Transferred. A transfer to another military medical treatment facility. The

AAD Report will show the facility to which transferred.
(a) Newborns.
(b) All others.
d. Change of Status Out. The temporary absence of a patient who is expected

to return.
(1) To leave. Convalescent leave is an authorized leave status granted to

active duty uniformed service members while under medical or dental care which is a part
of the care and treatment prescribed for a member’s recuperation or convalescence.
These days are not counted as occupied bed days but are counted as sick days when the
convalescent leave occurs prior to disposition of the patient. Convalescent leave occurring
after disposition of the patient while en route to a new command or convalescent leave
granted by a line commander after patient discharge from the hospital is not counted as
occupied bed days or sick days. The patient may also be put on regular leave.
(2) To subsisting out. The nonleave status of inpatients no longer assigned a

bed and residing away from the medical treatment facility. Subsisting out days are not
counted as occupied bed days but are counted as sick days. These patients are not
medically able to return to duty but their continuing treatment does not require a bed
assignment and they reside locally.
(3) To AWOL. Self-explanatory.
(4) To absent sick in nonmilitary MTF. The status of Army personnel

hospitalized in facilities other than those of the U.S. Armed Forces and for whom
administrative responsibility has been assigned to the reporting MTF (see AR 40-3 for
details).
(5) To TDY/SDY. A patient sent TDY while in an inpatient status. An example

is an inpatient sent TDY to appear before a physical evaluation board.
MD0752 1-44
(6) To PCS home or VA hospital. An inpatient sent home or to a VA hospital
pending the decisive of the Army on disability. If PCS home, the patient does not require
continuous medical care; if PCS to VA hospital, the patient requires continuous medical
care, probably for a prolonged period of time.
(7) From absent sick to leave. A service member in facilities other than those
of the U. S. Armed Forces is place on a convalescent leave.
(8) To supplemental care. Those medical services and supplies provided to

beneficiaries under specified circumstances by a civilian source when the patient remains
under the primary control of a uniformed services MTF (U.S. MTF) and the care is paid for
by MTF operating funds. Patients receiving inpatient services will be continued on the
hospital rolls (sick days) of the U.S. MTF and will be charged the U.S. MTF inpatient rate
appropriate to their patient category. This transaction is normally used to send patients to
a civilian medical treatment facility for testing or treatment that the military MTF cannot
provide. The testing and/or treatment requires the patient to remain overnight at the civilian
MTF.
(9) To cooperative care. Those medical services and supplies provided to

beneficiaries under specified circumstances by a civilian source for which CHAMPUS will
share in the cost even though the patient remains under the primary control of the U.S.
MTF. Patients receiving inpatient services will be
continued on the hospital rolls (sick days) but will not be charged the U.S. MTF inpatient
rate. This transaction is normally used to send patients to a civilian medical treatment
facility for testing or treatment that the military MTF cannot provide. The patient remains
overnight. This transaction is never used for active duty military.
(10) To the medical holding unit. This is essentially the same as “to subsisting
out.” This is usually for those people who live in the barracks or are not assigned to the
installation where the MTF is located but need to stay for treatment at the MTF.
e. Other Transactions.
(1) Interward transfers. When a patient is moved from one ward to another, it
is called an interward transfer. Generally, the specialty clinic changes at the same time.
(2) Carded for record only CRO. A term which applies to those special cases
for an admission, although no admission has actually occurred.
MD0752 1-45
(3) Transient patient (numerical strength).
(a) Remaining from previous days.
(b) Plus (+) arrived.
(c) Minus (-) departed.
(d) Equals (=) remaining.
(4) Boarders (numerical strength).
(a) Remaining from previous days.
(b) Plus (+) arrived.
(c) Minus (-) departed.
(d) Equals (=) remaining.
(5) Corrections of prior AAD reports. Errors made on previous AAD reports
are corrected in this part of the AAD report.
f. Separate Foreign Nation Listings. When foreign inpatients are on the rolls of
an Army MTF, a separate listing, not more than one nation per page, for each nation
having patients admitted, transferred, discharged, or deceased is included. The section
headings are printed in both English and French unless the representative of the foreign
government agrees to accept the report only in English. A copy is forwarded to medical
authorities of each nation having patients listed on the AAD report. See figure 1-13.
MD0752 1-46
Garmisch General Hospital (US Army) Date: 1 September 198X
Garmisch, Germany APO 09053 SERIAL NUMBER: 244-8x
NAME
Last, First, MI Grade/Rank Service Number Unit
(Nom, Prenoms) (Rang) (Numero Matricul) (Fraction) or Regiment
ADMISSION TO HOSPITAL (A L’HOSPITAL)
SMYTHE, B.S. CPL 987654 2 nd Royal

W. Lancers
BPO 88
Diagnosis: 1 Traumatic amputation of left hank, complete, without mention of complication. 2. Injury
to spleen, with open wound into cavity. Placed on the Very Seriously Ill (VSI) list at 1500 hours,
1 September 198X. Nonbattle Accident/Injury.
TRANSFERRED (TRANSFERT) TO QUEENS ROYAL ARMY HOSPITAL, LONDON
HAILEY, John CPT 2985777 1 st Royal

P. Lancers
BPO 89
Diagnosis: Ulcer of stomach, with hemorrhage. Sick/Disease.
DISCHARGE FROM HOSPITAL (DECHARGE DE L’HOPITAL)
GLENE, Glen E. COL 478069 HQ, BAOR

BPO 78
Diagnosis: Influenza with pneumonia. Returned to duty with Joint Allied Task Force, Garmisch. Sick/Disease.
HUME, Dick J. CPL 687596 2 nd Royal

Lancers
BPO 88
Diagnosis: Dislocation of patella. Returned to duty with parent unit. Nonbattle Accident/ Injury.
DIED IN HOSPITAL (DECEDE A L’HOPITAL)
LONER, Sam L. MAJ 0945678 1 st Royal

Lancers
BPO 89
Diagnosis: Hemorrhage of cerebellum. Sick/Disease. Underlying Cause of Death: Cerebral Hemorrhage.
Note: Hospitals preparing this list by mechanical means, using lines one and three of the admitting plate, will
include the register number, ward, or type of case.
Figure 1-13. Sample of AAD listing required for NATO patients.
g. A sample AAD report is shown in figure 1-14.
MD0752 1-47
H FORT SPLENDID TEXAS 75002
ADMISSION AND DISPOSITION REPORT
DATE -31 JAN 8X

2400 HOUR REPORT ENDING 2400 HOURS
031-8X
1. GAINS (ADMISSIONS)
A. DIRECT ADMISSION TO HOSPITAL
177304 HAMMER WALTER A PV2 20 55602 18 55 CO A 16 ENG BN B4 INJ BA

177264 KAWDITTLE FRED M PV1 20 15520 72 48 CO B BDE 6 DIV B3 DIS AP
177267 SNIDER PERE F SFC 20 15643 23 23 AMEDD CO USAH A3 INJ AA
ARMY RETIRED (A30)
177260 MARTIN GENE W MSG 20 56879 08 43 PDRL USA EM B3 DIS BH
ARMY DEPENDENT ACTIVE DUTY (A50)
177265 ROSENBAUM JAN J 30 24670 72 22 WIFE USA AD 1LT C4 DIS AA

177262 TURNER HAL V 01 48580 70 74 SON ARMY AD LTC 83 INJ AN
NAVY ACTIVE DUTY (N10)
177263 JONES DARRELL J CPO 20 15643 43 33 USS FOX A3 INJ AL
NAVY DEPENDENT ACTIVE DUTY (NSO)
177266 BABYLON PATRICIA C 03 38799 98 23 DTR USN AD CDR A4 DIS BA
AIR FORCE ACTIVE DUTY (F10)
177248 CURLEY ROBERT E LTC 20 56898 37 6 AIR BASE WING A5 INJ AA
AIR FORCE RETIRED (F30)
177252 ZANDA WILLIAM A TSGT 20 49493 83 82 TDRL USAF EM A5 INJ AE

C. TRANSFER ADMISSION
ARMY ACTIVE DUTY (A10)
177111 SLACK BERNARD L PFC 20 40361 62 74 AMEDD DET USAH A3 INJ AA
AIR FORCE ACTIVE DUTY (F10)
177280 WELLNER DANIEL S. AMN 20 06970 65 67 6 AIR BASE WING A5 DIS AA
Figure 1-14. Sample Admission and Disposition Report (continued).
MD0752 1-48
DATE - 31 JAN 8X
A& D REPORT (CONTD)
2. CHANGE OF STATUS IN
A. FROM LEAVE
177234 PADDICK EUGENE C MSG 20 33252 77 89 B BTRY 57 ARTY B3 DIS AA
C. FROM AWOL (LESS THAN 10 DAYS)
177235 LORANGE JOHN M PFC 20 47936 57 82 C BTRY 59 ARTY B8 DIS BD
3. LOSSES (DISPOSITIONS)
A. RETURNED TO DUTY
177101 PALMERMO JOHN A PV2 20 52445 21 05 A BTRY 1 HOW BN A1 DIS FA

177104 WILLIAMS RICHARD J PV2 20 52484 80 95 20 SPT TRANSBN A3 DIS FC
NAVY ACTIVE DUTY (N10)
177086 HELWIG GUNTER F SSG 20 62235 83 10 CO B 2 BN 1 DIV A3 DIS FC
G. DISCHARGE FROM HOSPITAL

(2) ALL OTHER NONMILITARY PERSONNEL
ARMY RETIRED (A30)
177403 ROWELL MARIANNE F MAJ 20 14675 77 41 TDRL USA OFF A1 DIS AA
ARMY DEPENDENT ACTIVE DUTY (A50)
177603 WELLNER DOROTHY J 30 25279 21 90 WIFE AD USA SFC B3 DIS AA
NAVY DEPENDENT ACTIVE DUTY (N50)
177125 PARTRIDGE SALLIE D 30 21357 36 12 WIFE AD USN LJG B3 DIS AA
R. K. WILLIAMS
MAJ, MS
Chief, Patient Administration Division
Figure 1-14. Sample Admission and Disposition Report (concluded).
MD0752 1-49
h. Distribution of AAD Report. Distribution of the AAD report is locally determined.
Distribution of the AAD reports containing diagnostic information is limited to only
individuals having an official need for such information. All copies of the report, except the
record copy, can be destroyed after they have served their purpose. The record copy is
maintained for five years, after which it is destroyed in accordance with AR 340-18-9.
Section V. DISPOSITION PROCESSING
1-18. GENERAL
a. Each patient is evaluated by the attending medical or dental officer as soon as

possible after admission and reevaluation continues until disposition.
b. The commander of the Army medical treatment facility is responsible for

disposition of all patients at the facility, but this action is normally delegated to the
attending medical or dental officer. This attending officer is responsible to the commander
for proper and timely professional care of patients and continual evaluation of patients for
early and appropriate disposition. United States military patients are not retained in
medical facilities longer than the minimum time necessary for them to obtain the mental
and physical state required for duty or for separation from the active service if they do meet
retention medical fitness standards. Nonmilitary patients are not retained beyond the
minimum time necessary for release.
1-19. CLEARANCE
a. A patient dispositioned to duty or discharged may be required to visit various

sections of the hospital for clearance. In some facilities, there is a centralized clearance
area which clears the patient. No standard pattern exists for clearance procedures. The
nursing unit personnel will direct the patient in clearing, taking into consideration the
nursing unit location in relation to the location of sections to be cleared and the condition of
the patient. DA Form 4029 (Patient’s Clearance Record), which was prepared on the
patient at time of admission, will be used for clearance. The clearance record includes all
sections of the medical facility that may be concerned with the patient; that is, library, Red
Cross, clothing room, medical services account office, and so forth. The admission and
disposition office generally is the last clearing point. Verification that clearance was
properly accomplished by the patient is the responsibility of the sections initiating the
appropriate item on the clearance record.
MD0752 1-50
b. When the patient arrives at the admission and disposition office, the admission
and disposition clerk will assure that all sections have been cleared. When proper
clearance is indicated, the clerk, when required, coordinates the arrangements to have
the patient returned to his organization. This includes vehicular transportation, rail tickets,
or contact with the patient’s sponsor. If the patient is unable to clear, the admission and
disposition clerk makes the necessary clearance by telephone.
c. Upon departure of the patient, the clearance record is set aside and used to
select the patient admitting plate from the current admitting plate control file. The plate is
placed in the admission and disposition file. The day of departure of the patient (before
2400 hours) is the day of disposition and the day of listing on the admission and
disposition report.
NOTE: The military member’s organization is responsible for providing transportation.

The AAD clerk checks to assure transportation has been provided.
Continue with Exercises
MD0752 1-51
EXERCISES, LESSON 1
INSTRUCTIONS: Answer the following items by marking the lettered response that best
answers the item by completing the incomplete statement, or by writing the answer in the
space provided at the end of the item.
After you have completed all of these items, turn to “Solutions to Exercises” at the
end of the lesson and check your answers . For each exercise answered incorrectly,
reread the material referenced with the solution.
1. The funds and valuables turned in by the patient are recorded on:
a. DA Form 3153 (MSA Patient Ledger Card).
b. DA Form 3696 (Patient’s Deposit Record).
c. DA Form 4029 (Patient’s Clearance Record).
d. DA Form 4160 (Patient’s Personal Effects and Clothing Record).
2. The act whereby an inpatient case is no longer carried on the rolls of a

U.S. military hospital is called: ________________________________.
3. Name the five types of admission.
a. .
b. .
c. .
d. .
e. .
MD0752 1-52
4. You are processing a patient for admission to your MTF, you have
obtained a register number, and interviewed the patient, you would now initiate:
a. DA Form 3696 (Patient’s Deposit Record).
b. DA Form 4029 (Patient’s Clearance Record).
c. DA Form 2985 (Admission and Coding Information).
d. DA Form 3647-1 (Inpatient Treatment Record Cover Sheet).
5. SSG James is being admitted for treatment of injuries he received in an

automobile accident. What special reporting action should be performed?
a. Telephone the finance and accounting officer.
b. Prepare a statement for the patient’s signature.
c. Send the DA Form 2985 to the Recovery Judge Advocate.
d. Send a notice to the medical services account officer.
6. What two files are used to prepare the AAD report?
a. .
b. .
7. What are the three conditions incorporated into the requirements for admission to
an Army medical treatment facility?
a. .
b. .
c.
8. Define the term “admission.”
MD0752 1-53
9. What information does the admission clerk enter on the register number log when
a register number is assigned?
.
10. Prior to leaving the hospital at 1200 hours, 28 October 198X, to report to duty,
the patient is given scheduled appointments for outpatient follow-up. His date of
disposition from the hospital is:
a. 28 October.
b. 29 October.
c. The date of the first outpatient visit.
d. The date of the last outpatient visit.
11. Who should be notified if a member of Congress, Vice President of the United
States, or a foreign dignitary reports to your MTF to be admitted?
12. Identify the five major headings of the AAD report.
a. .
b. .
c. .
d. .
e. .
13. The color of DD Form 2A (Identification Card) used for military personnel on
active duty is:
a. Red.
b. Blue.
c. Green.
d. White.
MD0752 1-54
REQUIREMENT: For items 14-21, match the extracts or statements in Column A to the
correct plates as listed in Column B. Place a, b, or c in space provided to the left of
Column A.
COLUMN A COLUMN B
14. Embossed with three lines of data: a. Admitting Plate

Name of MTF
Location of MTF
Identification of Clinic b. Clinic Identification Plate
15. Embossed to show nine lines of

patient identification data in the c. Inpatient Identification
sequence indicated by DA Form Plate
2985.
16. Used to imprint information on DA

Form 3647-1.
17. Embossed with three lines of data:

Name, Grade
Register Number, FMP, SSN
Sex, Age
18. Used to imprint label for the Inpatient

treatment record folders.
19. May be combined with the nursing unit

plate to imprint information on clinical
record forms except the inpatient
treatment record cover sheet.
20. Includes information on name and

address of emergency addressee.
21. Used to prepare the admission and

disposition report.
MD0752 1-55
22. SITUATION: You are working in the admission and disposition office of the
Eisenhauer Army Medical Center, Fort Gordon, GA 30905. The date is 6 July 199X.
SFC Raymond E. Jones enters your office at 1315 hour and hands you a DA Form 2985
requesting admission to the MTF. You will verify his need for admission and his eligibility,
obtain a register number, and collect his patient information You will then enter the
appropriate information on the register number log and the DA Form 2985. Refer to the
tables in this lesson for some of the information.
SFC Jones is a 34 year old black male, an E-7, is married, has two children, and
lives at 1420 River Road, Augusta, GA, 30915, telephone number is 245-3315. He is a
member of the First Methodist Church. His social security number is 345-13-4039 and has
been in the Army for 13 years with an ETS of 3 March 199X. His unit is HHC, HQ CMMS.
He has never been hospitalized at Fort Gordon and is not on flying status. He is a medical
specialist in the US Army. SFC Jones is going to have general surgery for an
appendectomy. His wife, Jane W., same address and telephone number, is his
emergency addressee. The authority for admission is paragraph 4-1, AR 40-3.
REGISTER NAME
173624
173625
173626
173627
173628
173629
173930
Register Number Log (Exercise 22).
MD0752 1-56
DA Form 2985 (Admission and Coding Information) for exercise 22.
MD0752 1-57
23. Using the information you entered on the DA Form 2985 for SFC Jones, answer
the following questions:
a. What information would you enter on line 6 of the admitting plate (nine-line
plate)?
b. What information would you enter on line 3 of the admitting plate?
c. What information would you enter on line 1 of the admitting plate?
For items 24-28, select the correct major heading and subheading for the following
transactions in the AAD report .
24. A patient is transferred from Ward 4B, Orthopedics, to Ward 3B, General Surgery.
a. Change of Status In - From SDY.
b. Gains (Admissions) - Direct Admission.
c. Other Transactions - Interward Transfer.
d. Other Transactions - Correction to Prior AAD Report.
MD0752 1-58
25. An active duty patient who was initially admitted to a civilian MTF is brought to
your MTF for completion of treatment.
a. Gains (Admissions) - Direct Admission.
b. Change of Status In - From Supplemental Care.
c. Gains (Admissions) - Direct Admission, Absent Sick.
d. Change of Status In - From Absent Sick.
26. A dependent leaves without being properly dispositioned by his physician.
a. Losses (Dispositions) - Discharge From Hospital.
b. Change of Status Out - To AWOL.
c. Change of Status Out - To Cooperative Care.
d. Losses (Dispositions) - AWOL.
27. An active duty Army patient is permitted to reside outside the MTF while
undergoing treatment.
a. Change of Status Out - To Subsisting Out.
b. Losses (Dispositions) - Patient to Duty.
c. Change of Status Out - To Supplemental Care.
d. Losses (Dispositions) - To Subsisting Out.
28. An Army dependent is admitted to your medical treatment facility from a civilian
hospital.
a. Gains (Admissions) - Transfer Admission.
b. Change of Status In - From Absent Sick.
c. Gains (Admissions) - Direct Admission.
d. Change of Status In - From Cooperative Care.
Check your answers on the following pages
MD0752 1-59
SOLUTIONS TO EXERCISES, LESSON 1
1. b (para 1-11a)
2. Disposition (para 1-3b)
3. Direct admission, direct absent sick admission, transfer admission,

carded for record only, newborn admission. (para 1-3a(1)).
4. c (para 1-7d)
5. c (para 1-14c)
6. AAD file; AAD control file. (para 1-16)
7. Must be medical indication that the patient’s condition warrants hospitalization.

Patient must be authorized to receive care. Type of treatment or care must be authorized.
(para 1-4a)
8. The act of placing an individual under treatment or observation in a medical center

or hospital. (para 1-3a)
9. Patient’s name, grade, SSN, organization, type of case, and nursing unit.
(para 1-7c)
10. a (para 1-17c)
11. Medical Command (para 1-13a)
12. Gains, change of status in, losses, change of status out, other transactions.
(table 1-12 and paras 1-17a-j)
13. c (para 1-2a (1))
14. b (figure 1-5)
15. a (para 1-9c)
16. a (para 1-11c)
17. c (figure 1-5)
18. a (para 1-11e)
MD0752 1-60
SOLUTIONS TO EXERCISES, LESSON 1 (Continued)
19. c (para 1-9e)
20. a (fig 1-4; para 1-8y)
21. a (para 1-16)
SOLUTION FOR EXERCISE 22 (para 1-7c)
REGISTER NAME
173624 Jones Raymond E SFC 345-13-4039 HHC HQ CMMS DIS
173625
173626
173627
173628
173629
173930
Register Number Log (Solution Exercise 22).
MD0752 1-61
DA Form 2985 (Solution for Exercise 22)
MD0752 1-62
23. (See DA Form 2985 preceding page; figure 1-4)
a. MRS J W JONES/W
b. 20 34513 40 39 HHC HQ CMMS C1
c. 173624 JONES RAYMOND E SFC
24. c (para 1-17e(1))
25. d (para 1-17b (4))
26. a (para 1-17c(7))
27. a (para 1-17d(2))
28. c (para 1-17a(3))
MD0752 1-63
LESSON ASSIGNMENT
LESSON 2 Absent Sick Processing.
LESSON ASSIGNMENT Paragraphs 2-1 through 2-8.
2-1. Identify a patient, that could be categorized as absent

sick.
2-2. Define absent sick.
2-3. Given a list, select the MTF that would have

administrative responsibility for an absent sick patient.
2-4. Given a list, select the administrative responsibilities

an MTF would have for an absent sick patient.
2-5. Given a list, select the proper disposition of the

copies of the SF 1034 for (Public Voucher for Purchases
and Services Other Than Personal.)
2-6. Given a list, select the approving authority for

payment of civilian MTFs.
2-7. Given a situation, initiate an SF 1034 for payment of

care from a civilian MTF.

lesson objectives.
MD0752 2-1
LESSON 2
ABSENT SICK PROCESSING
Section I. ADMINISTRATION OF ARMY MILITARY PATIENTS IN CIVILIAN

MEDICAL TREATMENT FACILITIES (MTF)
2-1. INTRODUCTION
Lesson 1 explained the circumstances under which an active duty (AD) Army patient
can be authorized care in a civilian MTF. When an AD Army patient is admitted to a
nonmilitary MTF or is placed in quarters by a non-Armed Forces, physician, the medical
commander in whose assigned geographic area the patient is located assumes
administrative responsibility for the individual.
a. When an AD Army patient is admitted to a nonmilitary MTF, he is in an absent

sick status.
b. When an AD Army patient is place in quarters by a non-Armed Forces physician,

he is in a sick-in-quarters status.
2-2. GEOGRAPHICAL AREA OF RESPONSIBILITIES
Specific geographic areas of responsibility are assigned to individual medical

treatment facilities by the Commanding General, U.S. Army Medical Command or in
overseas areas by an Army major overseas commander.
2-3. NOTIFICATION BY CIVILIAN MTF
Prompt notification that an AD Army patient is in a civilian MTF is important. An

Army MTF cannot assume administrative responsibility for or initiate action to return a
patient to military control unless it has knowledge of his confinement in the civilian facility.
Some AD personnel or civilian facilities do not know that an Army MTF should be notified
when an AD person is admitted to a civilian MTF. Without this notification, an individual
may be erroneously reported as absent without leave (AWOL). Therefore, it is important
that each Army MTF provide written notification to all civilian MTFs in its geographic area
of responsibility of the desired notification procedures. This notification should include
procedures for normal duty hours as well as after duty hours. It should include telephone
numbers and the appropriate section (e.g., admission and disposition office) or individual
(e.g., administrative officer of the day) to be notified. Information on billing procedures
should also be included to assist in the prompt payment of civilian facilities. Payment
procedures are covered in Section II.
MD0752 2-2
2-4. ADMINISTRATIVE RESPONSIBILITY FOR PATIENTS IN CIVILIAN MTF
Administrative responsibility of an Army MTF for patients in these circumstances

includes, but is not limited to:
a. Necessary professional medical evaluation and assistance. Prompt contact

between a physician at the responsible Army MTF and the attending civilian physician
should be make in order to determine the patient’s condition and the feasibility of
evacuation to a Federal MTF.
b. Notification to the patient’s parent unit and (when appropriate) temporary duty
organization.
c. Personnel functions for patients assigned and/or attached to a medical holding

unit.
d. Arranging government or civilian transportation for transfer between MTFs or

travel following completion of hospitalization.
e. Preparation of appropriate medical records and reports as required (e.g., SI/VSI

or death notification, line-of-duty investigation, etc.).
f. Preparation of vouchers for payment of care (see Section II) received by an AD

member in civilian facilities.
g. Preparation of bills to AD Army officers who are hospitalized in civilian hospitals.

They will be billed by the hospital Medical Services Account Office (MSAO) at the current
subsistence rate. (See Lesson 4 for procedures.)
Section II. PAYMENT OF CIVILIAN FACILITIES
2-5. COSTS AND FORMS
a. General. AD Army officers in civilian facilities pay the same subsistence rate
as they do when they receive care in an Army MTF. They are billed for this through the
MSAO of the MTF in whose geographic area of responsibility they were hospitalized. The
medical commander in whose assigned geographic area the patient is treated assumes
responsibility for the approval and payment of the civilian medical care obtained within their
geographic area.
b. Verification. The approving MEDDAC/MEDCEN verifies that the patient was

entitled to the services received and determines why care was not obtained from a Federal
MTF if one is in the vicinity of the place of treatment.
MD0752 2-3
c. Rates. The rates of compensation allowed for civilian medical care are
contained in AR 40-330 and DA Circular 40-XX-330. (The “XX” refers to the current FY.)
d. Forms Used. SF 1034 (Public Voucher for Purchases and Services Other
Than Personal) (see fig 2-1) is used to present charges for payment of services by civilian
facilities and care providers authorized in Chapter 17, AR 40-3. It is also used to
reimburse members who have paid for authorized civilian care when the civilian agency
requires immediate payment. When reimbursement is being claimed for payment to more
than one source, a separate voucher is prepared to cover each claim. Although entries on
the SF 1034 are self-explanatory, specific instructions are found in AR 37-107.
e. Supporting Documentation.
(1) Legible copies of invoices support the SF 1034. If an invoice is received

which is other than that produced by printer’s type, the initiator of the invoice and the
services provided are verified. When additional copies of invoices are required, they are
reproduced locally.
(2) SF 1034 for reimbursement to members must be supported by an invoice

as above and a receipt showing payment of the invoice.
f. Timeliness.
(1) It is essential that medical and dental bills from civilian agencies be paid as
soon as practicable after completion of the service. If, for some reason, a
MEDDAC/MEDCEN receives a statement of charges for which it does not have approving
authority, the bill is forwarded to the appropriate MEDDAC/MEDCEN and the civilian
agency is notified of the referral. There is now a 30-day processing time limit for payment
before the Government must pay interest. This must be avoided.
(2) Vouchers are prepared as soon as possible after receipt of the invoice.
(3) Statements and bills from civilian agencies must be fully itemized.
(4) Additional information required of members or civilian agencies is obtained

by telephone, if feasible, and a memorandum record of the call made.
MD0752 2-4
Figure 2-1. Sample of completed SF 1034 (Public Voucher for
Purchases and Services Other Than Personal).
MD0752 2-5
2-6. AUTHORIZED CHARGES
Charges not properly payable from Army funds may be deleted from the statement,
initialed by the approving authority, and the remaining charges processed for payment.
The civilian agency is advised by letter of the reason for deleting the charges.
a. Charges for services performed by those practitioners stated in paragraph 17-

2b(2), AR 40-3 are supported by the authorization (or copy thereof) of the licensed
practitioner requesting the services. When additional visits on the same date are made by
civilian physicians or when more than one physician provides care for a patient, this should
be explained. Charges for personal time for patients, such as cigarettes, personal
telephone calls, television, and meals for visitors, are not payable from Army funds.
b. When part of the necessary expense, official telephone and telegraph charges
incurred by civilian agencies in connection with medical care of authorized personnel are
included on their vouchers. A statement showing the points between which the service was
rendered, the date, the amount paid for each service, and an assertion that the telegrams
or calls were on official business is required. For local telephone calls, the voucher lists
the number of such calls, rates per call, the total daily amount expended, and a statement
stating the calls were on official business.
c. Charges for professional services by physicians or nurses who are not members
of the hospital or clinic staff are not included on a voucher in the name of the facility but are
vouchered in the name of the provider, except where the hospital or clinic has already paid
for the services. If a hospital or clinic has paid a physician or nurse who is not a staff
member, such charges may be included in the bill but must be accompanied by a
receipted bill showing payment by the facility. Hospital bills for professional services by
physicians, anesthetists, or nurses employed by the hospital will be annotated to reflect that
the provider was a “salaried member of the staff.”
d. Charges for nursing care will identify the place where the services were
rendered, the number of hours served daily, and the number of days or nights served.
e. Required items incident to treatment, such as crutches and special therapy,

must be listed separately.
f. Charges for dental services must show each service rendered, such as
extraction, restoration, treatment, etc., and the charge for each. Each tooth involved must
be identified.
g. Bills for ambulance service must show mileage and the rate per mile or the flat
rate, as the case may be.
MD0752 2-6
2-7. ADMINISTRATIVE CHARGES
Reasonable charges by civilian physicians or civilian medical treatment facilities for

furnishing medical records and reports are allowed when such services have been
requested by competent military authority.
2-8. DISPOSITION OF VOUCHERS
The disposition of vouchers (SF 1034) is as follows:
a. The original and three copies are forwarded to the local finance and accounting
office (F&AO) for payment.
b. The green copy is retained by the MTF.
c. The yellow copy is returned to the MTF by the F&AO after payment has been
made. The voucher will show the voucher number, check number, amount, and date the
check was listed.
MD0752 2-7
EXERCISES, LESSON 2
INSTRUCTIONS: Answer the following items by marking the lettered response that best
answers the questions, by completing the incomplete statement, or by writing the answer in
the space provided at the end of the item.
After you have completed all of these items, turn to “Solutions to Exercises” at the
end of the lesson and check your answers. For each exercise answered incorrectly, reread
the material referenced with the solution.
1. Which patient category can be absent sick?

a. Retired Army members.
b. Retired Army dependents.
c. Active duty Army members.
d. Active duty Army dependents.
2. The definition of absent sick is when an _______________ is admitted to a

_______________ MTF.
3. When charges are not payable from Army Funds, they will be deleted from an
invoice. The MTF will:
a. Advise the F&AO by letter.
b. Advise the member by letter.
c. Make a notation on the voucher.
d. Advise the civilian MTF by letter.
4. The yellow copy of a patient’s voucher is:

a. Retained by the F&AO for 90 days.
b. Returned to the MTF after payment is made.
c. Retained by the MTF until payment is made.
d. Forwarded to the payee when payment is made.
MD0752 2-8
5. It is the responsibility of, but not limited to, the ________________ to notify the
patient’s parent unit of an AD member status who is admitted to a civilian MTF.
a. Army MTF.
b. Red Cross.
c. Individual.
d. Civilian MTF.
6. If an MTF receives an invoice from a civilian facility outside their area, they:
a. Initiate the voucher for payment.
b. Return it to the civilian facility.
c. Forward it to Medical Command.
d. Forward it to the proper MEDDAC/MEDCEN and the civilian facility is notified of
the referral.
7. Who is responsible for arranging for transportation of an active duty member

following hospitalization in a civilian hospital?
a. Army MTF.
b. Individual.
c. Civilian MTF.
d. Individual’s unit.
8. The government is charged interest on medical and dental bills from civilian
agencies if bills are not paid within:
a. 15 days.
b. 30 days.
c. 60 days.
d. 90 days.
MD0752 2-9
9. The SF 1034 (Public Voucher for Purchases and Services Other Than Personal) is
forwarded to the:
a. MSAO.
b. Local F&AO.
c. Civilian MTF.
d. MTF comptroller.
10.When a patient is in an absent sick status, he has been admitted to a/an:

a. U. S. Army MTF.
b. U. S. Navy MTF.
c. Nonmilitary MTF.
d. U. S. Air Force MTF.
Check your answers on next page
MD0752 2-10
1. c (para 2-1a)
2. AD Army patient; nonmilitary. (para 2-1a)
3. d (para 2-6)
4. b (para 2-8c)
5. a (para 2-4b)
6. d (para 2-5f)
7. a (para 2-4d)
8. b (para 2-5f)
9. b (para 2-8a)
10. c (para 2-1a)
MD0752 2-11
LESSON ASSIGNMENT
LESSON 3 Medical Regulating and Aeromedical Evacuation.
TASKS TAUGHT 081-866-0121, Prepare for an Aeromedical Evacuation.

081-866-0129, Prepare Patient for an Aeromedical
Evacuation.
081-866-0130, Submit a Request for a Hospital Bed
Designation and Evacuation flight.
3-1. Define medical regulating.
3-2. Define patient evacuation.
3-3. Given a list, select the three reasons for evacuating or

transferring a patient.
3-4. Given a situation requiring patient evacuation within a

specified period of time and a list of movement
precedences, select the correct precedence.
3-5. Given a situation requiring a patient to be transferred

and a list of patient classifications, select the correct
classification.
3-6. Given a list of tasks to be performed prior to

evacuating a patient and a list of agencies or individuals,
select the appropriate agency/individual responsible for
each task.
3-7. Given a situation and the required forms used in the

evacuation process, complete the appropriate forms.

lesson objectives.
MD0752 3-1
LESSON 3
MEDICAL REGULATING AND AEROMEDICAL EVACUATION
Section I. INTRODUCTION
3-1. GENERAL
This lesson explains the many complexities of aeromedical evacuation and

describes the benefits to the Armed Forces medical services which result from having this
service available to military medical treatment facilities. The information in this lesson will
prepare you for assignments within the Army Medical Department (AMEDD) involving the
administrative processing of patients entering this phase of military medicine. The patient
is the primary concern in the overall mission of the Armed Forces medical services.
Therefore, medical service personnel must be prepared in all phases of care and
treatment to assure that the patient’s rehabilitation and ultimate return to duty as efficiently
and expeditiously as possible.
3-2. LEVEL OF TREATMENT
Military patients are treated at the lowest level, equipped, and staffed to provide
necessary medical care consistent with evacuation policies. If treatment required is not
available at the facility providing area hospital care, the patient is transferred to the most
readily accessible uniformed service medical treatment facility that possesses the required
capability. A member of a uniformed service is transferred, when necessary, to the
nearest uniformed service hospital (in relation to place of military assignment) having the
capability to provide the necessary care. A patient who is not expected to return to duty
within a reasonable time or who is expected to be retired or separated is transferred, when
necessary, to the uniformed service medical treatment facility nearest the patient’s home if
such facility has the capability for the required care and disposition.
3-3. EVACUATION AND REGULATING
At this point in the lesson, you need to understand that there is a difference between
regulating and transferring or evacuating a patient.
a. Patient Evacuation. Evacuation is the timely and efficient movement of

wounded, injured, or ill persons from the battlefield and other locations to medical treatment
facilities and from these facilities to other facilities for additional treatment. Evacuation
begins at the locations where the injury or illness occurs and continues as far rearward as
the patient’s medical condition warrants or the military situation requires.
MD0752 3-2
b. Medical Regulating. This is a system for coordinating and controlling the
movement of patients through the various levels of health service support. It is designed to
ensure the timely and efficient evacuation of patients to medical treatment facilities which
are best capable of providing the necessary treatment and having the required number of
beds available. Medical regulating is effectively accomplished when it functions at the
same headquarters which controls the evacuation means and the destination MTF. A
responsive communication system expedites the receipt of mission requests and the
issuance of mission assignments.
3-4. REASONS FOR EVACUATION OR TRANSFERRING PATIENTS
There are several reasons for moving patients from one MTF to another once the
patient is under medical control. For the most part, these reasons fall into one or more of
the following general categories:
a. Medical. Since all uniformed service hospitals are not identical in capabilities
and facilities, a MTF may find it necessary to transfer a patient to another MTF that has the
capability to provide the necessary treatment. The determination to move a patient for
medical reasons is made by the attending physician with the approval of the hospital
commander.
b. Administrative. Even though a MTF may have the capability to provide the
care a patient requires, sometimes the patient may need to be transferred for the benefit of
the government rather than for purely medical reasons. The member who is being
considered for separation or retirement due to his medical condition is a good example.
When the patient is in a inpatient status, it may be necessary to transfer the patient to a
MTF nearest the Physical Evaluation Board. Prior to moving a patient for purely
administrative reasons, the hospital must obtain approval from the Health Services
Command.
c. Compassionate/Personal. Transfers for compassionate or personal reasons

are normally patient generated. For example, the soldier who incurs an injury or disease
requiring an extended period of hospitalization may be transferred. Disregarding the fact
that the MTF in which he is hospitalized has the capability to provide the necessary
treatment and there is no basis for an administrative move, the patient could be transferred
to a location near his home if the physician feels it is in the best interest of the patient.
Approval for a compassionate or personal transfer must be obtained from Medical
Command prior to transfer.
MD0752 3-3
3-5. MISSION AND ADVANTAGES OF AEROMEDICAL EVACUATION
a. The primary mission objective of an aeromedical evacuation system is

comparable to that of any fixed military medical treatment facility: To reduce the
noneffective personnel rate of the Armed Forces resulting from injury and disease; in brief,
to increase combat availability of personnel in both peace and war.
b. The advantages of aeromedical evacuation (see figure 3-1) are:
(1) Speed. The primary advantage gained by air evacuation is the immediate
availability to move a patient rapidly, safely, and in a medically acceptable manner from a
location having a limited or no medical treatment capability to a facility which can provide
the necessary medical treatment. An advantage accruing to this is a reduction in recovery
time for the patient and his earlier return to duty.
(2) Flexibility. Patients can be diverted en route to the appropriate specialized

treatment facilities. This permits the Army Medical Department to establish specialized
treatment centers which can provide maximum hospital benefits to a maximum number of
patients at any one given time. A major benefit accruing from this capability is the
conservation of critical medical manpower at the professional level. The concentration of
medical skills in central areas reduces the requirement to staff all military medical facilities
at the specialty skill level. In addition, a considerable saving of paramedical manpower,
such as nurses, warrant officers, and medical specialists is realized from the use of air in
patient evacuation.
(3) En route treatment. In-flight medical treatment can be provided patients by

trained medical specialists who are members of the aircraft crew.
(4) Comfort. Travel by air is relatively more comfortable than travel by ground
vehicle over rough roads and uneven terrain.
(5) Morale. The morale of the fighting soldier is increased when he realizes
that he will be evacuated rapidly to excellent medical treatment facilities if he is wounded.
MD0752 3-4
ADVANTAGES OF AEROMEDICAL EVACUATION
1. Speed.
2. Flexibility.
3. En route Treatment.
4. Comfort.
5. Morale.
BENEFITS ACCRUING FROM AEROMEDICAL EVACUATION
1. Use of specialized treatment facilities.
2. Concentration of medical skills in central areas.
3. Conservation of critical professional medical manpower.
4. Conservation of paramedical manpower.
5. Early return to duty.
6. Lower morbidity and mortality rates.
Figure 3-1. Advantages and benefits of aeromedical evacuation.
3-6. AEROMEDICAL EVACUATION POLICY
It is the policy of the Department of Defense (DOD) that in both peace and war, the
movement of patients of the Armed Forces shall be accomplished by airlift when airlift is
available and conditions are suitable for aeromedical evacuation, unless medically
contraindicated. Aeromedical evacuation is performed only by units specifically assigned
an aeromedical evacuation mission, except when the service cannot be provided by an
aeromedical evacuation unit. In such instances, the installation commander and the senior
medical officer must authorize evacuation by local aircraft.
3-7. GENERAL EVACUATION POLICIES
a. Eligibility Status. Determination of eligibility for admission to the receiving MTF

and/or aeromedical evacuation is the responsibility of the sending MTF. Eligibility for care
does not automatically mean eligibility for air transportation.
b. If the prognosis indicates that the patient will be returned to duty within a
reasonable period of time, transfer is made to the nearest uniformed service MTF having
MD0752 3-5
the capability to provide the necessary medical care. If the prognosis indicates prolonged
hospitalization or an anticipated separation or retirement, the patient will normally be
transferred to the uniformed service MTF nearest the patient’s residence that is capable of
providing the required care and disposition.
c. Military members will be transferred to the nearest uniformed service MTF

without regards to the patient’s branch of service or the branch of service operating the
MTF.
d. Movement of patients is accomplished by airlift when airlift is available and

conditions are suitable, unless medically contraindicated.
3-8. DETERMINATION
Although the responsibility for determining that a patient should be medically

evacuated is the physician’s, everyone involved in the evacuation process needs to be
aware that aeromedical evacuation should not be routinely considered in the following:
a. Patients in the infectious stage of serious communicable diseases. If the patient

is evacuated, the inpatient treatment record (ITR) should be tagged to note the
communicable disease.
b. Patients whose general condition is so poor that they are unlikely to survive the
evacuation.
c. Patients whose upper and lower jaws are wired together. Fixation wires must
be replaced by rubber bands if evacuation is deemed necessary. In situations where wires
are not replaced, patients should have scissors attached to their clothing, unless a
psychiatric patient.
d. Patients who are pregnant may be moved at any gestational age, providing the
patient’s water has not broken nor active labor has begun. Specific length of pregnancy
should be reported.
e. Patients with any of the following conditions or equipment requirements will

require special consideration.
(1) Respiratory embarrassment.
(2) Cardiac failure (cannot be regulated until 10 days postmyocardial infarction

or 5 continuous days without complications or arrhythmias).
(3) Trapped gas within any of the body cavities, e.g., pneumothorax.
MD0752 3-6
(4) Severe anemia.
(5) Chest tubes.
f. Patients with any of the following conditions will require special handling.
(1) Paraplegic patients are transported on the Stryker frame.
(2) Patients with active pulmonary tuberculosis should be considered infectious

and should therefore be in respiratory isolation wearing a mask. The exception to this rule
is documented evidence that the patient has been on adequate chemotherapy for several
weeks. For patients who are air evacuated, it should be documented that they have been
on chemotherapy for two weeks and, therefore, a mask is not ordinarily needed. If the
patient is expectorating, the patient is required to cover the mouth when coughing; an
ample supply of tissue is sent with the patient. Patients generally do not need to remain on
a litter when they have been ambulatory at the hospital. If a mask is deemed necessary by
the physician in charge, the mask is kept on at all times except when eating. Smoking is
discouraged. There is no fear of personal articles infecting other personnel on the aircraft.
(3) Patients with severe burns are not transferred to Brooke Army Medical
Center, Fort Sam Houston, Texas, without the consent of the Commanding Officer, U.S.
Army Institute of Surgical Research, Brooke Army Medical Center, Fort Sam Houston,
Texas.
(4) Viral hepatitis cases are not generally infectious and only general hygiene is
observed. Hepatitis patients who are incontinent or have diarrhea are treated with enteric
precautions.
3-9. AGENCIES INVOLVED IN EVACUATION AND TRANSFER
a. Global Patient Movement Requirements Center (GPMRC). Located at

Scott Air Force Base, Illinois, the GPMRC is a joint agency of the Army, Navy, and Air
Force established by the DOD charter to regulate and monitor the transfer of patients
worldwide. At the time of its inception as a DOD agency, the Army Chief of Staff (ASC)
was appointed as Executive Agent to provide staff assistance to the agency.
Consequently, the Army Surgeon General was designated as the Executive
Representative to the ACS. Operational 24 hours daily, the agency performs its primary
mission of designating appropriate hospitals to receive patients. The GPMRC maintains a
constantly updated listing of the capabilities of all CONUS DOD medical facilities and
regulates (assigns destination hospitals) for nearly all inpatient transfers to and within
CONUS. The GPMRC also regulates armed service patients transferred to Veterans
Administration and Public Health Service hospitals. Patients are regulated through the
GPMRC regardless of the mode of transportation used to effect the transfers.
MD0752 3-7
b. Theater Patient Movement Requirement Center (TPMRC). The TPMRC is
a joint agency normally located at or near the overseas theater headquarters and which
functions under the supervision of the theater surgeon. The functions of the TPMRC
include: consolidating requests for transfers to CONUS facilities and maintaining direct
liaison with the GPMRC, MROs of component services, and transportation agencies which
furnish evacuation transportation. Additionally, the TPMRC will obtain periodic reports of
available beds from the MROs of services providing hospitalization, and based on
reported bed availability, select medical centers or hospitals to receive patients. The
TPMRC will be formed only when more than one service provides hospitalization in the
theater of operations.
c. U. S. Army Medical Command (MEDCOM). Although not actively engaged in

the day-to-day operations of evacuating and transferring patients, MEDCOM monitors the
movement of patients from one MTF to another within the Command. The Patient Affairs
Branch (HSC-OP-PA) is available to provide guidance and assistance when needed and
must be consulted prior to transferring a patient for administrative, compassionate, or
personal reasons.
d. Aeromedical Evacuation Control Center (AECC). Headquartered at Scott

Air Force Base, Illinois, the AECC is responsible for coordinating air transportation and
in-flight medical treatment for patients with the USAF flight squadron and both the
originating and destination MTFs.
e. Aeromedical Evacuation Coordinating officer (AECO). An officer of an

originating, in transit, or destination MTF who coordinates aeromedical evacuation
activities of the facility is the AECO.
Section II. PEACETIME PROCEDURES AND RESPONSIBILITIES
3-10. GENERAL
The concepts and principles of medical regulating and patient evacuation are the
same for domestic and combat evacuation. However, the combat situation necessitates
different operating procedures. For this reason, the procedures for these two situations
are being discussed separately.
MD0752 3-8
3-11. EXPLANATION OF TERMS
In Section I of this lesson, the difference between medical regulating and patient
evacuation was explained as were the names and basic functions of many of the agencies
involved. Additional terms you need to be acquainted with are listed below.
a. Aeromedical Evacuation. The movement of patients under medical

supervision to and between treatment facilities by air transportation.
b. Aeromedical Evacuation System. A system which:
(1) Centralizes control of patient transport by aircraft.
(2) Provides specialized medical attendants and equipment for in-flight medical
care.
(3) Provides facilities, on or in the vicinity of airstrips and airbases, for limited
medical care of patients entering, en route within, or leaving the system.
(4) Provides communication with destination and en route medical facilities

concerning patient transportation.
c. Aeromedical Staging Facility (ASF) (An Air Force Asset). A medical

element operating transient patient beds located on or in the vicinity of an airbase or
airstrip that provides reception, administration, processing, ground transportation,
feeding, and limited medical care for patients entering or leaving an aeromedical
evacuation system. The five within CONUS are located at Travis, Lackland, Scott,
Keesler, and Andrews Air Force Bases.
d. Ambulatory Patient. A patient requiring only seat accommodations while in

transit.
e. Attendant. Any individual, other than a member of the medical crew, who is
authorized by competent medical authority to accompany a patient when such attendance
is considered essential to the medical support or the mental or physical well-being of the
patient. Attendants are comprised of two basic categories as follows:
(1) Medical attendants. These are normally armed forces medical personnel
(although they may be medical personnel of civilian or other Government agencies) who
are required to accompany a patient on orders of competent medical authority because of
a mental or physical condition.
(2) Nonmedical attendants. These are generally family members (not

necessarily a requirement) who are authorized by competent medical authority when
MD0752 3-9
considered necessary for the health and welfare of the patient. These attendants function
under the supervision of the senior flight nurse aboard the aircraft and will provide care and
support of patients as directed by that individual. Escorts and guards for prisoner patients
fall within this category.
f. Destination Medical Facility. The medical facility to which the patient is being
transferred.
g. Domestic Aeromedical Evacuation. That phase of aeromedical evacuation

which provides airlift for patients between points within CONUS and between points within
an overseas theater (intratheater) during peacetime.
h. Litter Patient. A patient requiring litter (stretcher) accommodation while in

transit.
i. Member Patient. A person serving on active duty in one of the uniformed

services of the United States. Active duty means full-time duty in the active uniformed
service of the United States. It includes duty on the active list; full-time training duty;
annual training duty; and attendance, while in the active uniformed service, at a school
designated as a service school by law or by the Secretary of the department concerned.
j. Nonmember Patient. Any eligible person other than a member of a uniformed

service as defined above.
k. Originating Medical Facility. A medical facility that initiates or requests the

transfer of a patient to another medical facility.
l. Recovered Patients. Those individuals discharged from treatment by

competent medical authority who are physically able to travel unattended.
m. Remain Overnight (RON). Remaining overnight in a facility awaiting onward

transportation to a destination hospital.
3-12. REQUESTS AND REPORTS TO GLOBAL PATIENT MOVEMENT

REQUIREMENTS CENTER (GPMRC)
The GPMRC is a joint agency of the Army, Navy, and Air Force which regulates or
monitors the transfer of patients to medical treatment facilities. Medical regulating applies
to the transfer of all member and nonmember patients within CONUS and from overseas
areas. A request is made by an individual medical treatment facility in the CONUS or by a
Theater Patient Movement Requirements Center (TPMRC) which consolidates requests
from an overseas area. Specific instructions for preparing requests will be given later in
this lesson. Certain exceptions to procedures and responsibilities are noted below:
MD0752 3-10
a. No request to the GPMRC is necessary when referring patients to another
medical treatment facility on an outpatient basis. Data may be obtained from the ASMRO
concerning specialty capabilities.
b. Patients may be transferred between medical treatment facilities in accordance

with local agreements which have been reviewed by the tri-service regional review
committees or affected regions and approved by the Surgeons General. An after-the-fact
report of each patient so transferred will be submitted to the GPMRC by message or
telephone within 48 hours.
c. A patient who is a bonafide emergency case (see para 3-14d for URGENT or
PRIORITY) may be transferred without prior approval from the GPMRC if the transferring
facility first determines that the receiving facility has the capability to provide the required
medical care. An after-the-fact report to the GPMRC is required within 48 hours.
d. Requests and reports to the GPMRC are not necessary when members of the
Army, Air Force, Navy, and Marine Corps are hospitalized in civilian facilities with
CONUS and are moved to medical treatment facilities which have administrative
responsibility. If a patient is to be moved to a facility which does not have administrative
responsibility, a request is made to the GPMRC.
e. Hospital to hospital referral may be required for special handling of some

patients. Such referrals are reported to the GPMRC following coordination, but prior to
actual transfer of the patient.
f. Patients with severe burns may be transferred to the U.S. Army Institute of
Surgical Research (USAISR), Brooke Army Medical Center, Fort Sam Houston, Texas.
Direct communication is authorized with the USAISR to determine if a bed is available and
if the individual is an appropriate patient for transfer and is sufficiently stable for movement.
The USAISR will be notified by telephone or message within 24 hours after the admission
to an Army medical treatment facility of a patient with severe burns. A special burn team
may be dispatched to the medical treatment facility to aid in
early treatment and to advise on transportability. An after-the-fact report of transfer to the
USAISR is made by the transferring facility to the GPMRC within 48 hours.
g. A patient may be returned to the originating medical treatment facility in the

CONUS for continuation of treatment and/or disposition without further reference to the
GPMRC if the authority for return is included in the patient’s orders. The original GPMRC
control number is cited.
h. If a patient is to be transferred from the CONUS to an overseas area, a request,

including information as to the necessity for such transfer, is submitted to the Surgeon
General of the uniformed service concerned for approval.
MD0752 3-11
i. Nonfederal, tourist, and privately employed patients in overseas areas do not
require GPMRC approval for aeromedical transportation. Authorization for these patients
is obtained through the United States Consular Office abroad in accordance with Foreign
Affairs Manual 360.5-3 and DOD 4515.13-R.
3-13. REPORT OF SPECIALTY AVAILABILITY OR CURTAILMENT
Within ten working days following the end of each quarter, the Surgeons General of
the Army, Navy, and Air Force will furnish the GPMRC with a list of specialties available at
specified medical treatment facilities. When referral must be curtailed at any facility, the
facility commander will notify, as appropriate, one of the following: Army Surgeon General,
ATTN: DASG-HCP; CHBUMED (Code) 39 for the Navy; or Air Force Surgeon General,
ATTN: SGPC. An information copy is forward to the GPMRC and, in the case of an Army
facility, to the Commander of the U.S. Army Medical Command.
3-14. ATTENDING PHYSICIANS’ RESPONSIBILITIES
The attending physician determines when a patient should be medically evacuated.

The physician must balance the patient’s fitness for travel with the availability of suitable
medical attention, urgency of treatment, and evacuation time involved. The physician will
also:
Figure 3-2. DA Form 3981 (Transfer of Patient).
a. Prepare the DA Form 3981, Transfer of Patient (see figure 3-2) with the
approval of the department chief of chief, professional activities, and have the request
handcarried to the Patient Evacuation Section, Patient Administration Division, as soon as
MD0752 3-12
possible. This request will start a number of important administrative actions that must be
accomplished prior to the evacuation of the patient.
b. In the case of hospital to hospital transfer, normally the attending physician will
contact the destination medical facility and obtain an accepting physician.
c. Notify nursing service personnel of the planned evacuation and annotate the
doctor’s orders. Nursing service has a number of functions to perform prior to patient
evacuation and early notification will assist them to ensure completion of these
preparations. See paragraph 3-15.
d. Determine Precedence of Patient. The following precedence applies to all

patient evacuations. Overclassification will be avoided to prevent unnecessary, costly, and
hazardous movements.
(1) URGENT. For emergency cases that must be moved immediately to save
life or limb or to prevent complication of a serious illness. Psychiatric cases or terminal
cases with a short life expectancy are not considered urgent.
(2) PRIORITY. Patients requiring prompt medical care not available locally.
Patients must be picked up within 24 hours and delivered with the least delay.
(3) ROUTINE. Movement of patients on routine scheduled flights. Psychiatric

and terminal patients may only be classified as routine.
e. Determine patient movement classification. Any change in patient classification

after a patient has been reported for evacuation must be reported immediately to the
patient evacuation section. The configuration of aircraft, placement of patients on the
aircraft, and the type and number of crew members is dependent on the classification of
the patient. See table 3-1.
f. Determine diagnoses and whether a medical attendant is required. Physicians,

nurses, or medical corpsmen attendants must be approved by the appropriate department
chief and chief, professional activities, and a TDY request forwarded for issuance of
orders. The name of the medical attendant is indicated by the attending physician
requesting evacuation of the patient. The sex and degree of medical expertise is
determined by the physician and annotated on the DA Form 3981 (Transfer of Patient).
Nonphysician medical attendant’s responsibilities are under the direction of the flight
clinical coordinator. For those patients with a communicable disease, the flight clinical
coordinator is consulted to plan in-flight management of the patient. All medical attendants
are required to accompany their patients to the destination MTF. Attendants are released
by the attending physician and/or chief, patient administration division (PAD), at the
gaining MTF.
MD0752 3-13
I. NEUROPSYCHIATRIC PATIENTS
a. CLASS XA (1A) - Severe psychiatric patients requiring use of litters, restraint apparatus, and
sedation while in transit and at destination. Those who require close supervision at all times.
b. CLASS XB (1B) - Psychiatric patients requiring use of litters, sedation, and/or restraint apparatus
while in transit and require special watch aboard aircraft and at intermediate stops.
c. CLASS XC (1C) - Psychiatric Walking Patient of Moderate Severity - Psychiatric patients who are
cooperative and how have proved reliable under observation.
II. PATIENTS OTHER THAN PSYCHIATRIC
a. CLASS XDA (2A) - Immobile litter patients unable to move about of their own volition under any
circumstances.
b. CLASS XDB (2B) - Mobile litter patients able to move about on their own volition in an emergency.
c. CLASS XE (3) - Walking patients, other than psychiatric, who require minor attention en route.
d. CLASS XEI - Infants under 3 years of age occupying a seat.
e. CLASS XF (4) - Troop class walking patients, other than psychiatric, who require no medical
treatment and are physically able to travel unattended. (Class XF Army military patients will be returned to
CONUS through administration channels rather than aeromedical evacuation channels.)
f. CLASS XG - Ambulatory drug abuse patients.
g. CLASS XGA - Litter drug abuse patients.
h. CLASS XEO - Outpatients.
i. CLASS XX - Recovered patients-- NO CARE EN ROUTE.
j. CLASS XCO - Infants under 3 years of age.
k. CLASS XCO - Recovered infants under 3 years of age released from patient status and returning to
home station.
A third letter “O” will be used to identify outpatients, e.g., XFO, XEO, SCO.
NOTE: All pajamas classified as litter should be clothed in hospital pajamas and delivered to the aircraft on
a properly prepared litter.
Table 3-1. Classification of patients.
MD0752 3-14
g. Indicate in-flight medications, special diets, or equipment needed on the patient
evacuation worksheet. If in-flight medications are required, provide a 3-day supply of
medication for patients traveling in the Continental United States (CONUS). A minimum 5-
day supply of medication should be provided for patients traveling from overseas areas to
CONUS.
h. Complete the patient’s ITRC Worksheet, DA Form 3647 (Inpatient Treatment

Record Cover Sheet) and the SF 502 (Narrative Summary). The Narrative Summary
serves as a medical summary of the patient’s condition and reason for the transfer and
assists the gaining physician and in-flight personnel. The Inpatient Treatment Record along
with the completed and signed transfer summary should arrive at the patient evacuation
section NLT the day prior to evacuation for routine evacuation.
i. Review and sign DD Form 602 (Patient Evacuation Tag).
j. Coordinate with the flight coordinator on all seriously ill/very seriously ill (SI/VSI)
patients or other patients who require special attention and consideration during the
aeromedical evacuation process. These patients would probably be urgent or priority
evacuations.
3-15. NURSING SERVICE RESPONSIBILITIES
Nursing Service will:
a. Obtain Preflight Medications and Special Equipment. The ward nurse will
obtain any required special equipment and medications and will administer the preflight
medications according to instructions and orders of the attending physician. In-flight
medications are not sent with the patient, but are picked up by the patient evacuation
section personnel the day of departure. Normally, a 5-day supply of medications for
CONUS bound patients and a 3-day supply for other patients is obtained from the
pharmacy. All narcotics must be signed by patient evacuation personnel when received in
order to maintain control and a chain of custody.
b. Request Special Diets. The ward nurse will request from Food Service early
meals on the ward and modified diet meals for flights when required. (A minimum of 1-
day’s notice is required to prepare modified diet meals.) Patient evacuation personnel will
obtain these meals from Food Service the day of the flight.
c. Determine Need for Dressings. Clean dressings are applied just prior to the
patient’s departure, particularly to colostomies, draining wounds, burns, pressure sores,
and ulcers. Patients requiring frequent dressing changes are provided with a 24-hour
supply. Colostomies require frequent dressing en route because of increased intestinal
gas pressure from altitude changes. A 5-day supply of ostomy dressings should be
provided.
MD0752 3-15
d. Obtain Any Additive Support. Intravenous (IV) sets and fluids, including
additives, will accompany the patient during the flight when required.
e. Accomplish Any Need for Bladder Catheterization. If catheterization is

required, the ward nurse should request the ward physician to determine whether or not an
in-dwelling catheter should be inserted. In cases requiring catheter irrigation, a supply of
solution is provided to accompany the patients. If constant drainage is necessary, 4 to 5
feet of draining tubing and draining bags are included.
f. Obtain/Accomplish Other Special Needs of Patients.
(1) Supports/splints are provided for paralyzed extremities to prevent footdrop

or other complications. Paraplegic patients are on Stryker frames. Cervical injuries should
be in traction or Thomas collars, if traction is not deemed appropriate. Patients who have
undergone intraocular surgery or have a severe eye disease are classified as litter
patients. Tuberculosis patients are classified as litter patients. Patients are evacuated in
hospital clothing and masked. Adequate supply of masks are provided. Special items
such as incubators, croupettes, monaghan, respirators, etc., should be available upon
request.
(2) Class XA neuropsychiatric cases are brought by Nursing Service personnel

on a litter in pajamas, sedated, and restrained when necessary. A medical card with
dosage and time of last sedation given to Class XA and XB cases will accompany patients
as an aid to the flight clinic coordinator.
(3) When evacuating a litter patient, Nursing Service personnel pick up a field
type litter, blanket, pillow, litter straps, and restraints, if required, from the patient
evacuation section or medical supply NLT the day prior to the patient’s departure. Litter
patients are moved by nursing personnel to the evacuation staging area. Patients should
be in the staging area NLT 30 minutes prior to departure. Patient evacuation personnel
notify the wards on the time the patient is required to be in the staging area. Nursing
Service personnel are responsible for the proper preparation of the litter.
(4) Nursing services furnish an attendant to accompany the patient(s) to the

flight line when the attending physician designates the need for special medical attention.
Female chaperones are required when unaccompanied female patients are evacuated.
Attendants (usually patient administration specialists) control medical records and drugs
en route. As much lead time as possible is provided to the patient evacuation personnel.
(5) Direct all ambulatory patients to the baggage room to process outbound
baggage NLT the day prior to flight. Ward personnel must make arrangements for
movement of baggage to the baggage room for all non-ambulatory patients.
MD0752 3-16
(6) Specific capabilities of the rotary or fixed wing aeromedical evacuation
personnel and aircraft are obtained prior to evacuation.
(7) Prior to the morning or night of the patient’s departure, the nurse-in-charge
will ascertain that the last written doctor’s orders, nursing notes, and nursing care plan are
attached to the DD Form 602 (Patient Evacuation Tag) and are given to the patient
evacuation clerk upon his request.
3-16. PATIENT EVACUATION SECTION RESPONSIBILITIES
The patient evacuation section, under the supervision of the AECO, receives all
requests from physicians for evacuation of patients to another MTF on the DA Form 3981
(Transfer of Patient). Once a request has been received, the Patient Evacuation Section is
responsible for all administrative actions and coordination required to accomplish the
transfer. The patient evacuation section will:
a. Review the DA Form 3981 submitted by the physician (see figure 3-2).
Physicians will specify the type and number of attendants required. When a specific
hospital in CONUS is desired, the name of an accepting physician and telephone number
is required. The GPMRC may contact the accepting physician to verify the acceptance
before authorizing the transfer.
b. Obtain all the administrative information needed to request that the GPMRC
regulate the patient. A patient evacuation worksheet is designed to record all data needed
for this request (see Section IV for suggested format). This information can be obtained
from:
(1) DA Form 3981.
(2) The inpatient treatment record initiated at the time of admission.
(3) Interviewing the patient or family member.
c. Coordinate with the appropriate agencies to accomplish the transfer. All

CONUS evacuees are reported to the local GPMRC in accordance with local regulations.
All information required must be accurately completed.
d. Complete the DD Form 602, (Patient Evacuation Tag) (see Section III) and
obtain the physician’s signature. This form is utilized as both the doctor’s orders and the
patient’s medical record while en route. Physicians, when signing the form, are
responsible to insure that it has been properly prepared and that the information entered is
correct. Diagnoses entered include only such detail that will be useful in caring for the
patient during evacuation. En route medication with prescribed dosage must be entered.
If a patient requires tube feeding, a copy of the feeding formula is attached. This form is
MD0752 3-17
completed and signed NLT the day prior to evacuation. The DD Form 602 should
accompany the medial records.
e. Conduct a briefing for patients and attendants on the patient evacuation system
and evacuation rules. If patients are unable to come to the patient evacuation section, the
patient evacuation clerk will go to the wards to brief the patients. Patients are briefed at
least two days prior to their departure. The orientation explains the evacuation processing
that is required and answer questions patients/attendants may have concerning their
evacuation. Patients are given Military Airlift Command Pamphlet 164-4, “Information for
Patients,” if available. The briefing relieves anxiety and assists in preparation for the trip.
Briefings can be written and/or verbal and include the following:
(1) The manner in which the aeromedical evacuation system operates.
(2) The necessity for RON and regrouping of patients.
(3) Specific routing, when known; otherwise, approximate routing.
(4) Estimated time en route.
(5) Baggage limitations.
(6) The need for personal funds, appropriate dress, and US Department of
Agriculture and customs inspections.
(7) The availability of in-flight insurance.
(8) Passport and visa, reentry, residency, and custom requirements.

(NOTE: Expectant mothers must have all necessary documents for
proper registration of births.)
(9) Facilities available and rules governing stay of patients and their families
at CONUS airports.
(10) Antihijacking procedures to include limitations of stowed and handcarried

baggage which is searched at time of evacuation (see figure 3-3).
(11) Any information that will be helpful to the patients.
(12) What type of clothing they are authorized to wear.
MD0752 3-18
f. Arrange with food service for pickup of meals for patients on modified diets as
prescribed by the attending physician. Infant formulas are supplied by the originating
pediatric nursing unit. Food service is notified of delayed or cancelled flights.
g. Record on DA Form 3161 (Request for issue or Turn-In), all government property
accompanying a patient. A copy of the travel orders on each patient aeromedically
evacuated and the completed DA Form 3161 are forwarded to the Chief, Property
Management Branch, in order to maintain accurate property accountability.
h. Ensure that all records to accompany patients are completed and present prior
to the patient’s departure. Military personnel patients or attendants will have in their
possession valid identification cards and a current immunization record. All others will
have in their possession a valid identification card, a valid passport with visa, when
required, and a current immunization record. It is the responsibility of the patient
evacuation clerk to ensure that the patient’s chart is closed out properly prior to shipment of
the patient. It is the clerk’s responsibility to forward the personnel, health, and finance
records to the gaining unit.
i. Ensure all travel orders have been prepared for active duty and their dependents
and retired personnel and their family members.
j. Receipt for all baggage and valuables (see Section III). Patient’s baggage will
be properly packed, secured, and tagged. The weight limit is normally 66 pounds per
passenger. The containers may be duffel bags or suitcases; cardboard boxes can not be
used. Loose parcels are not accepted. Baggage is searched for dangerous articles,
flammables, and explosives (see figure 3-3). Patients are allowed one small handbag or
toilet articles, cigarettes, etc. All baggage is subject to a customs inspection. Property
exchange between medical facilities and the Air Force is accomplished in accordance with
AR 40-538.
k. Ensure the Patient Evacuation Tag, the Narrative Summary, and other records
are completed by the attending physician.
l. Check with ward to ensure Nursing Service has filled medication requirements,
arranged for any special equipment, and properly prepared the patient (e.g., sedated and
restrained).
m. Complete patient evacuation manifest (see Section III).
n. Arrange for support services such as ground transportation to aircraft;

assistance in loading patients aboard aircraft; and guard escorts for prisoner patients.
MD0752 3-19
Office Symbol Date
Memorandum For Aircraft Commander Aeromedical Evacuation Mission
SUBJECT: Certification of Anti-hijacking Check.
1. “I certify that a check of the following patients, medical and nonmedical attendants, and a physical
search of their handcarried items was conducted at the time this individual departed this medical facility,
and no explosive devices or unauthorized weapons were found.”
_________________________ _______________________________
Patient’s Name SSN
Signature and Title of Inspector
Figure 3-3. Memorandum for Aircraft Commander Aeromedical Evacuation Mission.
MD0752 3-20
Section III. PREPARATION OF REQUESTS AND FORMS FOR TRANSFER
3-17. PREPARATION OF REQUESTS FOR TRANSFER
Requests to the GPMRC for designation of uniformed service MTF may be by

message, telephone, or facsimile transmitting equipment. The GPMRC will respond by
the same means. Requests for transfer to a Veterans Administration hospital are by
message only (see AR 103-05 for message preparation instructions). Alphabetical and
numerical codes are used in reporting patients to the GPMRC for regulating. These codes
are used to identify such things as the patient’s departmental/civilian status,
diagnosis, classification, etc.
a. The most common and preferred method of requesting a patient be regulate is

by telephone. Upon GPMRC’s receipt of a request, the information is entered into a
computer. The information is then passed on, via computer, to the AECC. This “one-
stop” call reporting eliminates a duplication of calls for the evacuation clerk. Although there
is no required format, figure 3-7 and table 3-2 show the form on which the GPMRC records
the required information. A patient evacuation request sheet is designed to conform with
the GPMRC’s form to enable the request to me made in an efficient manner.
b. When the destination facility is named by the GPMRC, the transferring facility
must notify the receiving facility of contemplated transfer and arrange the necessary
transportation. The information provided will include the name and grade or status of the
patient; diagnosis and medical coding; information for advanced planning (such as
identification of general officer or other person whose identity is of congressional interest
or has public information implications); any personal or administrative considerations
which will impact on the receiving facility; mode of transportation; and estimated date of
departure from the transferring facility.
c. If a member patient requires transfer for personal, administrative, compassionate,

or humanitarian reasons (instead of purely medical reasons), the commander of an Army
facility will submit a request to the Commander of the US Army Medical Command. The
request will include the name, grade, social security number, and parent unit; the diagnosis,
prognosis, and present condition; the appropriate medical coding; the anticipated length of
further hospitalization; physical evaluation board status; home address; hospital desired;
statement of whether previous request has been submitted; reasons for submitting
request; and, if applicable, the name and title of the accepting physician at the receiving
facility. In reply, the U. S. Medical Command will include a GPMRC control number for
each approval. The GPMRC control number is cited on all orders authorizing or directing
the patient’s inter-hospital transfer. Special procedures for other uniformed services are
contained in AR 40-350.
MD0752 3-21
MD0752
3-22
Figure 3-4. ASMRO Form 1 (Defense Patient Evacuation
Office Data Input Sheet) (continued).
MD0752
3-23
Figure 3-4. ASMRO Form 1 (Defense Patient Evacuation Office Data Input Sheet) (concluded).
TELEPHONE REPORTING FORMAT
1. PATIENT’S NAME: Last, first, and middle initial. State if a junior, a II, III, etc.
2. AUTHORIZATION NUMBER: Self-explanatory.
3. SOCIAL SECURITY NUMBER: Use individual’s SSN or the sponsor’s if the patient is a dependent.
4. STATUS: Service affiliation or relationship to sponsor, i.e., USA/active duty: USMC, Retired/TDRL;
dependent daughter, USN/active duty; or dependent wife, USAF; Retired/ Deceased; etc.
5. GRADE: Required for active duty only. Member’s pay grade, i.e., E-4, 0-4, etc.
6. PRECEDENCE: Report patients as URGENT, PRIORITY, or ROUTINE as defined in AFR 164-

5/AR 40-535/OPNAVINST 4630.9C.
7. CLASS: Report patients as XA , XB, XX, etc., as defined in MAC Regulation 164-5.
8. AGE: State in years. If less than two years, then in months and if newborn, in days.
9. SEX: Report male or female.
10. WEIGHT: Self-explanatory. State in pounds.
11. REPORTED BY: Provide the name of the patient evacuation clerk who is reporting the patient.
12. TELEPHONE: Provide the telephone number of the reporting MTF. The telephone number must be
one which is readily available to receive incoming telephone calls.
13. MEDICAL SPECIALTY: Clinical specialty requirements(s), i.e., SOP, SOR, SNS, etc.
State the primary specialty first if more than one is required.
14. MEDICAL SPECIALTY: See item 13 above.
15. MEDICAL SPECIALTY: See item 13 above.
16. DIAGNOSIS: Use diagnosis codes contained in the International Classification of Diseases, ninth
revision, 1975 (ICD9). State primary ICD number first followed by others as appropriate. Also give
nomenclature of diagnosis.
Table 3-2. Telephone reporting format (continued).
MD0752 3-24
17. ORIGINATING MTF: Give name of MTF, i.e., NRMC Jacksonville, FL; OMA Charleston; or Walter
Reed AMC.
18. ORIGINATING CIVILIAN MTF: Give name and full address. Provide telephone number of that
treatment facility’s best contact point for the case involved.
19. DESTINATION MTF: Report as indicated in item #18.
20. DESTINATION CIVILIAN MTF: Give name and full address. Provide telephone number of that
treatment facility’s best contact point for the case involved.
21. VA CODE: Defense Patient Evacuation Office (DPEO) use only.
22. STATION CODE (ORIGINATING): DPEO and PAC use only.
23. STATION CODE (DESTINATION): DPEO and PAC use only.
24. ATTENDING PHYSICIAN/TELEPHONE: Provide the name and telephone number of the patient’s
attending physician.
25. WARD NUMBER/TELEPHONE: Report ward/telephone numbers where the patient is being treated.
26. ACCEPTING PHYSICIAN: Provide name of accepting physician at destination MTF when required
or otherwise arranged.
27. APPROVAL AUTHORITY: Give the name of the appropriate approving official for those cases
requiring special approval.
28. REASON REGULATED: DPEO use only.
29. DATE OF LAST VISIT: Provide the date of the most recent hospitalization on all follow-up cases.
30. TYPE BAG: Report as suitcase, duffle bag, foot locker, hanging bag, other, or no bag.
31. BAG TAG: All patients and attendants must have bags labeled in accordance with AFR 164-3/AR
40-40/BUMEDINST 4650.2A. Provide tag number(s) as required by reference.
32. BAG WEIGHT: Self-explanatory.
33. ADMIN/OVERSEAS: DPEO use only.
34. MODE: Report mode of patient travel, i.e., air evacuation, train, helicopter, bus, ground ambulance,
etc.
35. SUPPLEMENTAL: Report additional information as required for patient transfer.
TABLE 3-2 Telephone Reporting Format (continued)
MD0752 3-25
36. ATTENDANT’S NAME #1: See #1.
37. STATUS: See #4.
38. GRADE: See #5.
39. AGE: See #8.
40. SEX: See #9.
41. TYPE BAG: See #30.
42. BAG TAG: See #31.
43. BAG WEIGHT: See #32.
44. ATTENDANT’S NAME #1: See #1.
45. STATUS: See #4.
46. GRADE: See #5.
47. AGE: See #8.
48. SEX: See #9.
49. TYPE BAG: See #30.
50. BAG TAG: See #31.
51. BAG WEIGHT: See #32.
52. HISTORY: Report all information pertinent to the patient’s clinical history which will
assist in insuring optimal en route medical care.
VITAL SIGNS
53. TEMPERATURE: Report patient’s latest temperature.
54. PULSE: Report patient’s latest pulse rate.
55. RESPIRATIONS: Report patient’s latest respiration rate.
56. B/P (BLOOD PRESSURE): Report patient’s latest blood pressure reading.
57. HGB (HEMOGLOBIN): Report patient’s latest hemoglobin.
MD0752 3-26
58. HCT (HEMATOCRIT): Report patient’s latest hematocrit.
59. WBC (WHITE BLOOD COUNT): Report patient’s latest white blood cell count.
60. ABG (BLOOD GASES): Report patient’s latest blood gas analysis.
61. MEDICATIONS: Report medications required for patient while en route. e.g., name of drug,
dosage, frequency of administration, etc.
GENERAL DATA
62. SI/VSI: State whether patient is seriously ill or very seriously ill or seriously injured or very seriously
injured.
63. RON/#RON: Report whether patient’s condition permits all remaining overnights while en route. If
no, report number of RON’s permitted.
64. EN ROUTE STOPS /#STOPS: Report whether patient’s condition permits all en route stops. If no,
report the number of stops permitted.
65. ALTITUDE RESTRICTION/MAXIMUM HEIGHT: Report whether patient’s condition restricts altitude
while en route and if so, maximum allowable altitude.
66. CONDITION: Report patient’s state of consciousness, e.g., comatose, etc.
SPECIAL EQUIPMENT
67. OXYGEN/LPM: Report whether patient requires oxygen en route and if so, state flow requirements
in liters per minute.
68. SUCTION: Report patient’s requirement for suction while en route.
69. NG/TUBE: Report patient’s nasogastic tube requirements.
70. RESPIRATOR/TYPE: Report patient’s requirement for respirator while en route. If

respirator is required, report type.
71. FOLEY: Report whether Foley catheter is in place.
72. STRYKER: Report whether patient requires Stryker frame while en route.
73. TRACTION/LBS: Report patient’s requirement for traction while en route. If traction is required,
report number of pounds.
74. IMED: Report whether IMED is required.
75. MONITOR: Report if patient requires monitor en route.
76. INCUBATOR: Report patient’s requirement for incubator.
MD0752 3-27
77. SPECIAL DIET/TYPE: Report whether patient requires special diet and if so, report type of diet.
78. IV/TYPE: Report intravenous requirement, if any, and type.
79. BLOOD/UNIT: Report patient’s requirement for whole blood and number of units required while en
route.
80. TRACH/SIZE: Report whether or not tracheotomy is in place. If so, report size.
81. CAST/TYPE AND LOCATION: Report whether patient is in cast. If so, report type and anatomical
location.
82. CANX/INCOMPLETE: DPEO and PAC use only.
83. OTHER: Report pertinent information pertaining to patient not provided elsewhere.
84. CMTs: DPEO and PAC use only.
85. TRANS ORIG PHONE: Provide the telephone number of the office arranging transportation to the
aircraft at the point of origin.
86. TRANS DEST PHONE: Provide the telephone number of the office arranging transportation from the
aircraft to the destination hospital.
87. MISSION NO: PAC use only.
88. RON LOCATION: PAC use only.
89. VALIDATED BY/REASON HIGHER PRECEDENCE: PAC use only.
Table 3-2. Telephone Reporting Format (concluded).
d. A request for hospital designation will include the patient’s name, grade or status,
appropriate alphabetical and numerical coding, special medical requirements, and any
additional personal or administrative information which will clarify the needs or special
requirements of the patients. For a member patient, the request will include the duty
station (or home port for ship) if the patient is expected to return to duty or the place of
residence (not necessarily the home of record) for a member who is not expected to return
to duty. For a nonmember patient, the place of residence is specified. Modifications in
the data provided are necessary for patients to be transferred to Veterans Administration
hospitals (see figure 3-5).
MD0752 3-28
Figure 3-5. DD Form 173 (Joint Message Form – request for Hospital
Designation from CONUS MEDCEN).
MD0752 3-29
e. Figure 3-5 is an example of a request from a CONUS Army medical center to the
GPMRC for designation of a Veterans Administration hospital. Figures 3-6 and 3-7 are
examples of a consolidated request from a joint medical regulating office in an overseas
area and the reply from the GPMRC. Note the control number (8062) cited by the GPMRC
at the beginning and at the end of the message form.
f. Information in paragraphs (1) through (14) below indicates the codes used to
supply information to the GPMRC when requesting designations of hospitals by message.
(1) Code Departmental Status

A Member of United States Army.
N Member of United States Navy.
AF Member of United States Air Force.
M Member of United States Marine Corps.
CG Member of United States Coast Guard.
OA Commissioned Officer of National Oceanic
Atmospheric administration.
PH Commissioned Officer of Public Health Service.
(2) Alphabetical symbol to indicate patient’s sex and grade followed by letter “y”
if litter patient.
Code Status
A Male Officer or Warrant Officer.
B Female Officer or Warrant Officer.
C Male Enlisted.
D Female Enlisted.
EXAMPLE: ACY (Army male enlisted liter patient).
MD0752 3-30
Figure 3-6. DD Form 173 (Joint Message Form -- Consolidated Request or CONUS
Hospital Designations from Overseas Theater Patient Movement
Requirements Center).
MD0752 3-31
Figure 3-7. DD Form 173 (Joint Message Form – Reply from GPMRC to
Consolidated Request).
MD0752 3-32
(3) Alphabetical codes to indicate civilian status of nonmember patients of a
uniformed service.
Code Status
ACE Department of the Army Civilian Employee.
NCE Department of the Navy Civilian Employee.
AFCE Department of the Air Force Civilian Employee
DA Family Member of United States Army Military
Personnel
DN Family Member of United States Navy and Marine Corps
Military Personnel
DAF Family Member of United States Air Force
Military Personnel
DPH Family Member of Uniformed Services Member of United
States Coast Guard, Commissioned Corps of National
Oceanic Atmospheric Administration, or Commissioned
Corps of United States Public Health Service
ARC American National Red Cross Employee
CIV (Specify All Other Civilian Employees)
PHAS American Seaman
RET Retired Members of Uniformed Services Not On
Active Duty (Indicate Service)
(4) Supplement for nonmember patients who are beneficiaries of Office of

Worker’s Compensation Program. Enter (OWC) following the civilian status symbol.
EXAMPLE: STEVEN G JONES X99(OWC) SOR 8212 SAN ANTONIO TX
(5) Repatriated prisoner-of-war patients. The letters (RPW) will be added to

designate a member of the uniformed service of the United States or any United States
citizen who has been repatriated or otherwise returned to United States control.
EXAMPLE: A1C JOHN R ROE F11 (RPW) SOR 8212 ALBANY NY
(6) Medical classification. A combination of alphabetical and numerical codes

are used to indicate the medical specialty requirements and the specific diagnosis for
each patient. The alphabetical codes listed in paragraph (14) below will be used to
indicate the medical specialty requirements, and the diagnosis numbers listed in the
International Classification of Diseases, 9th Edition (ICD-9) (as modified by individual
service regulations) are used to indicate the specific injuries or illnesses. Patients whose
illness or injuries place them in more than one medical classification are multiple coded to
insure designation of an appropriate medical treatment facility. Also, multiple coding is
used where a patient’s illness or injury requires two or more specialty requirements. The
classification indicating the specialty service to which the patient should be admitted by the
receiving facility is reflected by initial coding. Some medical codes, such as observation
without need for further medical care and medical and surgical aftercare, are not sufficient
MD0752 3-33
to identify the patient’s medical needs when reporting to the GPMRC. When using such
nonspecific diagnosis codes, an additional diagnosis number or narrative statement will
identify the underlying medical conditions requiring observation or aftercare in order to
insure proper disposition of the patient.
EXAMPLE: SGS V584/5694--Surgical Aftercare for Perforation of Intestine.
(7) Reporting duty station or place of residence.
(a) CONUS patients. The patient’s duty station (include home for ships)
will be reported for each member of the uniformed services who is expected to return to
duty. The patient’s place of residence is reported for each member of the uniformed
services who is not expected to return to duty and all nonmember patients. The place of
residence also pertains to an Army member who is transferred for the sole purpose of
appearing before a physical evaluation board.
(b) Overseas patients. The patient’s place of residence is reported.

Whenarrangements have already been made with a civilian facility for acceptance and
care of a nonmember patient, verification of the facility name and location is ascertained by
the transferring medical treatment facility prior to reporting the patient. The name and
location of the receiving facility, name and telephone number of the accepting physician,
and the statement “ACCEPTANCE CONFIRMED” is included in the request. The
patient’s place of residence must be a city or town listed in the Directory of U.S. Post
Offices.
(8) Physical evaluation board patients. The term “PEB” is added to the entry for
member patients when it is anticipated that their illnesses or injuries will necessitate
appearance before a physical evaluation board.
EXAMPLE: A1C JOHN R DOE ALL SOR 8212 ALBANY NY/PEB.
(9) Enlistees under the Medically Remedial Enlistment Program. The letter ”X”
is added to the patient’s status code to identify an enlistee under the remedial program
who must be transferred for performance of therapeutic procedures.
EXAMPLE: JOHN R DOE F11X SGS 5500 HANCOCK FIELD NY.
(10) Prisoner patient. A request for destination for a prisoner patient will indicate
whether the prisoner is sentenced or unsentenced, type of discharge awarded, and
designated place of confinement.
(11) Alcohol and drug abuse patient. The medical specialty code shall be QAL
for alcohol abuse or QDR for drug abuse. In the case of an Army (overseas) drug abuse
patient, additional data is included to reflect status of the member’s transfer; for example,
MD0752 3-34
expiration of term of service and date, date and type of administrative discharge approved,
and so forth.
EXAMPLE: SP4 JOHN R DOE ALL QDR 3040 HOUSTON TX/ETS 12JAN9X.
(12) Identification of very important persons and flag or general officer. The rank
and/or title and the medial treatment facility desired is added to data on all important
persons and flag or general officers who are transferred in a patient status between
uniformed service medical treatment facilities. The appropriate Surgeon General of the
uniformed service concerned is included as an information addressee on the message
notifying the receiving facility of the patient’s transfer.
(13) Supplemental medical information. If the alphabetical and numerical codes

used to medically classify patients are not sufficient to regulate them to the proper medical
treatment facility, supplemental information should be included. An example would be the
requirements for the services of a proctologist, psychiatrist, podiatrist, and so forth; or the
need for special procedures such as renal biopsy. Likewise, in those cases where
patients are identified as potential teaching cases, reference should be made to such,
including information as to the desired medical treatment facility and whether the patient
has been accepted by the desired facility. Additional medical information is required in
cases where a specific facility is desired. In cases where patients have been scheduled
for performance of operations and nonsurgical procedures, include the name of the
medical treatment facility, the required procedures, and the date scheduled. The
supplemental medical information will follow the data pertaining to the duty station or place
of residence.
EXAMPLE: MRS MARY R DOE N41 MRD 7531 AKRON OH/RENAL

BIOPSY/ACCEPTED NH SDIEGO/CRO SMITH 93ANBX.
(14) Alphabetical codes used to identify medical requirements. The proper code
is used in accordance with the classification and definition. Extracts from AR 40-350 are
shown below:
Classification Code Definition
MEDICINE
Aerospace Medicine MAS Special evaluation and therapy for personnel on
Flying status with difficult diagnostic or prognostic
problems affecting fitness for flying duty.
Hemodialysis MHD Patients having endstage renal disease and

requiring hemodialysis to sustain life.
MD0752 3-35
PEDIATRICS
Pediatric Surgery PDS Patients in the pediatric age group requiring
specialized surgery, excluding heart and thoracic
surgery.
NEUROPSYCHIATRY
Psychiatric Intensive Care MAS Psychiatric patients requiring intensive ward care,
with special precautions, in a medical treatment
facility capable of providing specialized care for
psychiatric patients.
RADIATION THERAPY
Nuclear Medicine RNM Patients who require diagnostic procedures in
which radionuclides are used or in which treatment
with these isotopes are contemplated.
SURGERY
Aural Rehabilitation SAR Patients having, or suspected of having, defective
hearing or impairment of hearing to the degree
which will require the use of a hearing aid and who
will require aural rehabilitation.
Hand Surgery SHA Patients having, or suspected of having, diseases

or injuries requiring specialized reconstructive
surgery of the hand.
Neurosurgery SNS Patient having, or suspected of having, diseases

or injuries to the brain, spinal cord, or peripheral
nerves, It includes herniated nucleus pulposus,
causalgia, skull defects, and recent head injuries
for which neurosurgical treatment is indicated.
Ocular Prosthesis SOC Patients who require an ocular prosthesis.
Ophthalmology SOP Patients having, or suspected of having, diseases

or injuries of the eye requiring specialized
treatment. It includes retinal detachment,
intraocular foreign bodies, neoplasms, and
conditions requiring plastic surgery to the eyelid
and orbit.
MD0752 3-36
Orthopedic Surgery SOR Patients having, or suspected of having, diseases

or injuries of the musculoskeletal system, or
residuals thereof, for which surgical treatment is
indicated. Also included are conditions which
require reconstruction of deformed extremities and
diseases or injuries of bones and joints.
3-19. DD FORM 600 (PATIENT’S BAGGAGE TAG)
DD Form 600 (see figure 3-8) is prepared for and firmly affixed to each piece of
baggage which will move with the patient traveling by military common carrier in the same
train, aircraft, or vessel as the patient. When a patient’s journey is made in several
stages, one baggage tag per piece of baggage serves through all stages of the journey,
even though the patient is moved by more than one military common carrier. Identification
which will show the patient’s full name, social security number, grade, organization,
present station, destination, and home address is placed inside the patient’s
unaccompanied baggage. Patient’s baggage tag are NOT used for patient’s baggage
not moving in the train, aircraft, or vessel with the patient. Such baggage is moved as
ordinary unaccompanied traveler’s baggage in accordance with current directives.
a. Responsibility. DD Forms 600 are prepared and firmly affixed to baggage by

the medical treatment facility preparing a patient for the first stage of his journey. For
patients being moved from medical treatment facilities by other than those of the United
States military services, the carrier’s medical personnel prepare the forms.
b. Originating Carrier. Enter the designation of the military common carrier (for
example, “MAC” and “MSC”) which will accept the patient at the beginning of the journey.
c. Patients, Grade, Social Security Number. These entries are largely self-
explanatory. The symbol “NA” (not applicable) is used under “Grade” and “Service
Number” when the patient is a civilian.
d. Originating Medical Facility. Enter the designation and location (or APO) of
the medical treatment facility preparing the patient’s baggage tag.
e. Originating Terminal. The medical treatment facility preparing the baggage

tag enters the designation of the carrier’s terminal at which the first stage of the patient’s
journey begins.
MD0752 3-37
Figure 3-8. DD Form 600 (Patient’s Baggage Tag).
f. To Hospital, Terminal. The originating medical treatment facility enters in the

first line of this section of the tag the designations of the serving medical treatment facility
and terminal at which the first stage of the patient’s journey, the designations of the next
hospital and terminal at which he will stop are also entered.
MD0752 3-38
g. Destination Hospital, Destination Terminal. When the patient’s ultimate
destination is determined, as by receipt of assignment instructions from the GPMRC, the
designation of this hospital and the terminal at which the patient will be off-loaded are
entered under “Destination Hospital” and “Destination Terminal.” When the patient’s
ultimate destination is known to the medical treatment facility tagging the patient’s
baggage, as in movements between points in the United States, this medical treatment
facility enters the destination hospital and the destination terminal.
h. Patient’s Stub. Entries on the patient’s stub are completed when the tag is
prepared and the stub is given to the patient if he is able to safeguard it. If the patient is not
able to safeguard the stub, it is turned over to the senior medical attendant accompanying
the patient. As medical personnel accompanying patients are relieved, the patient’s stub
is turned over to the succeeding senior medical attendant. If a patient is not able to
safeguard his own possessions enters a medical treatment facility between stages of the
journey, responsible personnel of the medial treatment facility receive and safeguard the
stub and deliver it to the senior medical attendant accompanying him on the next stage of
the journey. At the destination terminal, the senior medical attendant then accompanying
the patient delivers the stub to the representative of the destination hospital accepting
delivery of the patient.
i. Disposition of Patient’s Baggage Tab. The patient’s baggage tag and the
accompanying patient’s stub are destroyed after delivery of baggage to the destination
hospital.
3-20. DD Form 602 (PATIENT EVACUATION TAG)
DD Form 602 (see figure 3-9) is prepared for each patient to be moved by a
military common carrier and is the patient’s in transit medical record. The attending
physician prescribes en route medical requirements on this form before the patient departs
the originating facility and all en route treatments are noted on the form during the patient’s
journey. The tag consists of three parts: the basic tag with ship’s record office information,
the embarkation tag, and the debarkation tag. Only the first tag is required for a patient
moving from one point to another in the United States. All parts of the form are required for
a patient moving from outside into the United States. Information pertaining to the “cabin or
compartment number” and the “bunk number” is entered by the carrier’s representative who
accepts the patient for transportation; otherwise, entries are made by the medical
treatment facility which delivers the patient to the carrier for the first stage of the journey. If
a patient’s journey is made in several stages so that he enters medical treatment facilities
for brief periods en route, the original tag is preserved by these facilities and affixed to the
patient’s clothing when he leaves for the next stage of his journey. Such medical treatment
facilities are referred to as “RON” (remaining overnight facilities), “holding facilities,” or
“debarkation facilities.” The hospital which undertakes further treatment of the patient at
the end of the journey is responsible for stapling the patient evacuation tag to the SF 502
MD0752 3-39
(Narrative Summary) in the Inpatient Treatment Record. This hospital is responsible also
for ensuring that appropriate interim notations are made in the individual’s medical record.
Figure 3-9. DD Form 602 (Patient Evacuation Tag).
MD0752 3-40
a. Completing DD Form 602.
(1) From (hospital). Enter the designation and location (or APO number) of
the medical treatment facility from which the patient’s journey originates.
(2) Name (last, first, middle initial). Self-explanatory.
(3) Social security (service) number and rank/rating/grade. Enter the

required information for military personnel; enter the symbol “NA” (not applicable) for
others.
(4) Category of personnel. For uniformed services personnel, enter the

appropriate service (for example, USAF, USA, USN, USMC, USCG, NOAA, USPHS). For
foreign personnel, enter the service and nationality using commonly intelligible
abbreviations. If the patient is a civilian employee of a national government, enter the
government and its department in which he is employed (for example, USAF Employee,
US State Department Employee, British Admiralty Employee). If the patient is a
dependent of a United States military member or of a United States civilian employee,
enter the relationship and the name of the person through whom he derives his entitlement
to Army medical care (for example, DTR, SGT JOHN J JONES). For other civilians
moved as patients, enter the nationality and the term “Civilian” as “US Civilian,” “French
Civilian,” “Canadian Civilian,” etc.
(5) Diagnosis. Enter all diagnoses and provide only such detail as will be
useful in caring for the patient during the journey. In red pencil, add to the diagnosis block
any of the following, if applicable: “prisoner,” “under investigation,” or “DA” (drug abuse).
(6) Class. Enter the class of the patient in the appropriate box (“1A” through
“4”). For this purpose, use the class described in table 3-1.
(7) Disease, battle, casualty, injury, condition. Check one of these spaces,
as applicable. Check “yes” or “no” to indicate if the patient is “very seriously ill.”
(Information is found on the Inpatient Treatment Record Cover Sheet.)
(8) Cabin or compartment number, bunk number. The cabin or compartment

number and bunk number assigned to the patient, if this information is required, is entered
by the carrier’s representative as the patient is loaded. If there is a previous entry, it should
be lined out and the current information entered.
(9) Baggage tag number. Enter the same baggage tag number that are
shown on DD Form 600.
(10) Destination. For a patient moving into the United States, enter the name
of the port of debarkation in the United States at which the patient will arrive. If this
MD0752 3-41
information is not available at the time the patient’s tag is prepared, enter the symbol “US.”
When a patient who has moved into the United States is prepared for movement from a
port of debarkation to a hospital in the United States which will undertake further treatment,
the medical treatment facility serving the port lines out the original entry in the “Destination”
space and substitutes the designation of the hospital which undertakes definitive treatment.
For a patient moving between points in the United States, the entry number “Destination”
is the name of the hospital to which the patient is being transferred.
(11) Treatment and diet recommended en route. Enter information necessary

for guidance of medical personnel accompanying the patient. If a regular diet is indicated,
check the appropriate box. If a special diet is required, describe the diet in the space
provided. If a patient requires tube feeding, the formula must be attached to the DD Form
602. Use the reverse of the tag to note examination and treatment en route if not of
sufficient importance to open the inpatient treatment record. Enter treatment administered
at medical treatment facilities en route, at staging facilities, or aboard the carrier. In
addition, enter (preferably by rubber stamp) the name of the facility and the dates of the
patient’s arrival and departure. The time of treatment will also be given when provided by
non-Army facilities.
(12) Date of shipment. When embarkation is required for a patient prepared

for movement into the United States, enter the date on which the medical treatment facility
delivers the patient to the military common carrier.
b. Disposition of Patient Evacuation Tag. The basic tag is inserted in the

patient’s Inpatient Treatment Record stapled to the SF 502 (Narrative Summary) by the
hospital to which he is transferred. The tag is a permanent part of the Inpatient Treatment
Record or, in the case of an outpatient, of the Health Record or Outpatient Treatment
Record. If the embarkation tag is prepared, it is detached by the preparing overseas
medical treatment facility as a patient is delivered to the carrier. The embarkation tag is
used as required locally and destroyed when no longer useful. The debarkation tag
remains attached to the basic tag until the patient reaches the port of debarkation in the
United States. The tag is detached by port personnel for local use and destroyed when no
longer useful locally.
3-21. RECORDS OF PATIENTS
The Inpatient Treatment Record and other pertinent medical records (including
Field Medical Cards, patient’s orders, laboratory reports, and x-rays) are place in an
envelope to accompany the patient to the hospital of final destruction. Pay and personnel
records should also accompany the patient when a permanent change of station is
involved. The envelope marked with the patient’s name, patient’s (or sponsor’s) rank,
social security number, nationality of not a US citizen, organization, date of departure, and
destination hospital. Histopathological sections accompanying the patient are prepared
for shipment to the appropriate uniformed services directive.
MD0752 3-42
3-22. FUNDS AND VALUABLES
Under ordinary circumstances, the patient withdraws funds and valuables on deposit
with the Patient’s Trust Fund prior to departure from the medical treatment facility. Where
this is not feasible, the fund custodian prepares a check drawn to the order of the patient
for the funds left on deposit. The check, valuables, and a letter of transmittal are sent by
registered or certified mail to the patient at his new address. Shipment through
aeromedical evacuation channels is resorted to only under unusual circumstances. In such
instances, the originating medical facility lists valuables on an appropriate document. This
document is prepared in responsibilities between the originating, interim, and destination
facilities. The initial receipting for patient’s valuables is the responsibility of the senior flight
nurse accepting a patient from the originating medical facility. Cash assets in excess of
twenty-five dollars are converted to a United States Treasury check or DD Form 114
(Military Pay Order) made payable to the patient concerned. The container for the
valuables and check is labeled showing the patient’s full name, grade, social security
number, and name and location of the originating medical treatment facility.
Section IV. COMBAT PROCEDURES FOR REGULATING AND EVACUATING

PATIENTS
3-23. INTRODUCTION
Although the concepts and principles of medical regulating and evacuation are the
same, the combat situation necessitates different procedures be used during wartime.
The combat procedures are discussed in this section.
3-24. EXPLANATION OF TERMS
In Section III, many of the terms were explained; however, there are additional
terms used primarily during combat situations that you need to be aware of. These terms
are defined below:
a. Evacuation Flow. Although patient evacuation flows from the point of first
medical care through the various levels of increasingly complex treatment (normal chain),
any medical treatment facility at any level may be bypassed when the condition of the
patient warrants and the evacuation means is available (see figure 3-10). This bypassing,
referred to as direct evacuation, does not alter the principles of patient management but
rather use the available air and surface evacuation means to the advantage of the patients
and his specific medical or surgical condition.
MD0752 3-43
Figure 3-10 Levels of Health Service Support
b. Forward Aeromedical Evacuation. The phase of aeromedical evacuation

which provides airlift for patients between points within the battle area, from the battle area
to the initial point of treatment, and to subsequent points of treatment within the combat
zone.
c. Intratheater Medical Regulating. The system by which patients are

transferred or evacuated from one hospital to another within the theater of operations. This
includes evacuations between combat zone hospitals, COMMZ hospitals, or from combat
zone hospitals to COMMZ hospitals.
d. Intertheater Medical Regulating. The system by which patients are

evacuated from hospitals located in the theater of operations to hospitals located in the
zone of the interior (ZI).
MD0752 3-44
e. Joint Military Transportation Board (JMTB). A joint staff composed of
members of the Army, Air Force, and Navy that coordinates transportation requirements for
patients requiring intertheater evacuation.
f. Means of Evacuation. The method of evacuation is determined by

availability, tactical situation, climatic conditions, and medical condition of the patient.
When both air and ground ambulances are used, specific factors are considered in
determining which patients are to be evacuated by air and those to be evacuated by
ground ambulances. Normally, the physician treating the patient (physician assistant or
aidman in the absence of a physician) makes this determination based upon the clinical
condition of the patient with primary consideration given to the evacuation means which
contributes most to the patient’s well-being.
g. Medical Command (MEDCOM). The MEDCOM provides evacuation,

hospitalization, preventive medicine, optical, environmental health, laboratory, dental,
veterinary, medical supply and maintenance, and other specialized health service support.
This command differs from other functional commands in that it provides local health
service support in the COMMZ as well as evacuation and hospitalization for patients direct
from the combat zone. The MEDCOM commander normally serves as the TA surgeon.
h. Military Sealift Command (MSC). The Navy element responsible for

coordinating movement of supplies, equipment, and personnel into the theater by US
Navy ships and for coordinating medical evacuation of patients by ship from the theater of
operations to zone of the interior (ZI), as required.
i. Movement Control Center (MCC). The Army unit which coordinates and
controls the movement of Army aircrafts and ground transportation within the theater.
Additional ground or air resources and clearance for their movement in support of
evacuation requirements from the combat zone that exceed U. S. Air Force capabilities
are coordinated through the MCC.
j. Mobile Aeromedical Staging Facility (MASF). A U. S. Air Force holding

facility employed at forward airfields in the combat zone to provide a patient holding
capability for patients being evacuated from corps hospitals to general hospitals.
k. Strategic Aeromedical Evacuation. That phase of aeromedical evacuation

which provides airlift for patients from overseas areas or from theaters of active operations
to the CONUS or to a temporary safe haven.
l. Tactical Aeromedical Evacuation Subsystem (TAES). A functional

organization provided by the U.S. Air Force designed to perform the mission of tactical
aeromedical evacuation. It is composed of the aeromedical evacuation control center
(AECC), the mobile aeromedical staging facility (MASF), the aeromedical evacuation
liaison (AELT), and the aeromedical evacuation crews.
MD0752 3-45
m. Theater of Operations. A theater of operations is that portion of an area of
conflict necessary for military operations, either offensive or defensive, pursuant to an
assigned mission and for the administration and logistical support incident to such military
operations. A theater of operations includes the area of land, sea, and air that is, or may
become, directly involved in the military operation. A theater of operations is both a
geographical area and a military command. Normally, the theater is divided into a combat
zone and a communications zone.
(1) A combat zone is that area required by combat forces for the conduct of
operations.
(2) The communications zone (COMMZ) is the rear part of a theater of

operations.
(3) The zone of interior (ZI) is that part of the national territory not included in
the theater of operations (CONUS, Alaska, Hawaii, Puerto Rico, Canal Zone, Virgin
Islands, American Samoa, Guam, Wake Island, Midway, and other minor islands.)
3-25. MEDICAL REGULATING WITHIN THE COMBAT ZONE
a. Due to surgical backlogs, mass casualty situations, a requirement to provide

specialty care, or the planned movement of a hospital, there may exist a requirement to
transfer patients from one hospital in the combat zone to another hospital within the combat
zone. In these cases, the attending physician will notify the hospital patient administrator
(PAD). The PAD will consolidate all such requests from the hospital and request
movement authority from the medical groups medical regulating office (MRO).
b. If the medical group can transfer the patient or patients to other hospitals
subordinate to it, the group will designate the hospital(s) to receive the patients and notify
the requesting and receiving hospitals of the transfer. The group will also task appropriate
subordinate evacuation units for the transfer of the patients to the designated hospitals.
c. If the group cannot provide the needed hospitalization within its resources, the
group MRO will forward the request to the medical brigade MRO for action. The medical
brigade MRO will then designate the receiving hospitals and notify the subordinate MROs.
Subordinate MROs will then designate the information to the appropriate hospital PAD’s
and coordinate evacuation resources for the transfer.
3-26. MEDICAL REGULATING FROM THE COMBAT ZONE TO THE COMMZ
a. Hospital attending physicians submit daily reports to the hospital PAD listing
the patients requiring evacuation. The PAD assembles all pertinent information and
transmits a report to the medical group headquarters to which the hospital is attached.
This report is a request for transportation as well as a notification of the number of patients
MD0752 3-46
requiring evacuation. The report classifies patients according to diagnostic category,
desired on-load points, and time patients will be available for evacuation.
b. The medical regulating officer at the medical group headquarters consolidates

these reports from each hospital attached to the group and forwards his report to the MRO
located at the medical brigade headquarters. The brigade MRO consolidates the reports
and transmits the data to the MEDCOM MRO located at the medical command
headquarters.
c. If the Theater Patient Movement Requirements Center (TPMRC) has been

activated within the theater, the MEDCOM MRO will consolidate all reports from the
combat zone medical brigades and forward them to the TPMRC. The TPMRC will
designate hospital centers or hospitals in the COMMZ to receive the patients from the
combat zone hospitals based on the previously received bed status reports from all service
components. The TPMRC will then notify the MEDCOM MRO of designated hospitals.
The MEDCOM MRO will accomplish this task if the TPMRC is not activated.
d. The primary means of moving patients from the combat zone to the COMMZ is
U.S. Air Force aircraft. With the elements of the TAES deployed, it is possible to find
aeromedical evacuation liaison officers/NCOs (AELO) at each level and as far forward as
the corps hospitalization facilities. The AELO monitors the MRO patient evacuation
requests and simultaneously uses its organic communication capabilities to pass
information through the TAES to the ALLC seeking an aircraft to perform the evacuation
mission. The AELO at the MEDCOM level requests the Military Airlift Command (MAC) to
move patients, indicating the originating medical facility and the destination airfield to
which the patients will be moved. The formal request is submitted to the aeromedical
evacuation control center (AECC). The airfields selected are those serving hospitals
designated to receive patients.
e. The AECC is a component of the TAES and provides the mission of

coordinating the movement of and providing in transit medical care to patients under the
control of the Air Force. The AECC will forward the request to a theater Air Force agency
known as the airlift control center (ALCC).
f. The ALCC coordinates with other units of the Air Force, Army transportation
representatives, and Navy agencies with respect to forward movement of cargo and
personnel aboard Air Force aircraft. Certain of these aircraft are scheduled to evacuate
patients on their return trip. The aircraft seldom will go forward solely to evacuate patients.
g. After the schedules have been arranged, the AECC will return the detailed flight
schedule to the MEDCOM AELO and the parent aeromedical evacuation squadron. The
MRO at MEDCOM can then determine whether or not Air Force resources are sufficient to
evacuate all patients from the combat zone. If the request exceeds the Air Force’s
MD0752 3-47
capabilities, the MRO will coordinate additional ground or air resources and movement
clearance from the movement control center (MCC).
h. The MEDCOM MRO issues these instructions to both the medical brigade
MRO, with the authority to move patients in Army combat zone facilities, and the receiving
hospital centers. The hospital centers must prepare to receive the patients at the
destination airfields, sort them, and move them by Army medical transportation means to
the various general hospitals selected by the hospital center. The instructions mentioned
above will include, as a minimum, the number of patients to be moved, the on-load
airfield, the destination airfield, the Air Force mission number of the aircraft which is to
move these patients, and mission time of arrival at the destination airfield.
i. The medical brigade MRO issues the flight and movement instructions to
subordinate medical group MROs. The group MROs will then direct the evacuation units
and hospitals within their groups to move the patients to the on-load airfield according to
the time of arrival of the aircraft. This movement must be closely controlled since the
mobile aeromedical staging facilities (MASF) can accommodate only a limited number of
patients and they cannot hold them for an extended period of time. As a rule, the patients
must be delivered to the MASF no earlier than four hours prior to arrival of the aircraft and
no later than two hours prior to arrival.
3-27. MEDICAL REGULATING WITHIN THE COMMZ
a. Medical regulating within the COMMZ is similar to the system described above
for medical regulating within the combat zone. Attending physicians within the field and
station hospitals notify the hospital patient administrator of patients requiring evacuation to
general hospitals. The PAD will then consolidate the requests from the hospital and
forward the consolidated request to the medical group MRO who will consolidate the
requests and forward them to the MEDCOM MRO.
b. The MEDCOM MRO, based on periodic bed status and availability reports
from subordinate hospital centers, will designate specific hospitals to receive the patients.
The hospitals are designated based on bed availability and specialty beds available to
support the specific patient. The MEDCOM MRO will then notify the requesting group
MRO of the designated hospitals and will notify the designated hospitals through the
hospital center MRO.
c. The group MRO will forward the hospital designations to the subordinate
hospitals and, concurrently, notify the evacuation units subordinate to it of the evacuation
requirements.
MD0752 3-48
3-28. INTERTHEATER MEDICAL REGULATING
a. Many of the patients who are evacuated within and to the COMMZ will be
treated there and returned to duty within the theater. Others, however, cannot be returned to
duty within the transfer and must be further evacuated to the zone of the interior. The
attending physician at the hospital will notify the PAD of those patients which must be
evacuated. The PAD will then consolidate these requests and forward them to the MRO at
the next higher headquarters (hospital centers in the case of general hospitals or medical
groups in the case of the field and station hospitals.) The group and hospital center MROs
forward the consolidated request to the MEDCOM MRO who consolidates and forwards
the request to the TPMCR , if it exists, or to the joint agency known as the GPMRC. If the
TPMCR exists, the requests from each component service will be consolidated and
forwarded to the GPMRC.
b. Upon request of the TPMRC for authority to evacuate patients to the zone of
the interior, the GPMRC will direct the distribution of these patients into hospitals
throughout the continental United States, advise the JMRO of the destination hospital, and
provide the authority for such movement. As a rule, these will be military hospitals. Other
Federal hospitals, however, may also receive patients. The Veterans Administration
hospitals, for example, may receive patients who are expected to be discharged from the
service. The GPMRC continues to coordinate with and inform MAC concerning future
movement of patients.
c. When the TPMRC receives the authorization to move patients, it will notify the
MEDCOM MRO of destination hospitals in CONUS. The TPMRC will coordinate with the
Joint Military Transportation Brigade (JMTB) to arrange movement of the patients to
CONUS. When the JMRO is not activated, the MEDCOM MRO, through his AELO, will
accomplish this task. The MEDCOM MRO will then authorize the movement of patients to
aeromedical staging facilities (ASF) collocated on airbases capable of handling long-
range aircraft (e.g., C-141). Transportation will be arranged, within Army channels, to
move patients from the hospitals to the staging facilities. The hospital centers will then
notify the subordinate general hospitals of the flight schedule and the evacuation
arrangements that have been completed.
d. The medical group MROs will notify their subordinate hospital of the flight
schedule pertinent to their evacuation request and task their subordinate evacuation units
to move the patients to the MAC terminals. At each of these MAC terminals, there is an
ASF established by the U.S. Air Force. When the patients are delivered to the Air Force
the responsibility for those patients is transferred from the MEDCOM MRO to MAC. Upon
arrival in the continental United States, the GPMRC assumes control but further movement
responsibility is that of the Air Force.
e. All patients will not be able to move by air from the theater to CONUS. In that
event, the Military Sealift Command (MSC) will be used to move them by surface means.
MD0752 3-49
This authority also comes from the TPMRC MEDCOM MRO which will have previously
arranged with the theater Navy for the movement of patients by hospital ships. When the
patients are moved by ships, the MEDCOM will have to provide holding facilities at the
port. Patients will be delivered to these holding facilities and held there until loaded aboard
ships. This is one mission of the field hospital.
3-29. MOBILE AEROMEDICAL STAGING FACILITIES (MASF)
a. Mobile aeromedical staging facilities (MASF) are air transportable holding

facilities. These units are equipped and staffed to receive patients, sustain life, and
administratively process patients who are to be moved in the Tactical Aeromedical
System. (TAES). This tactical system will be used to evacuate patients from Air Force
operational locations within the combat zone to hospital facilities outside the combat zone
and from airhead or airborne objective areas where airborne operations include Air
Force forward logistic support. Bases used for aeromedical staging and in-flight crew
staging are designated by the area or theater commander. Tactical aeromedical
evacuation crews provide supportive medical care, prepare patients for evacuation,
initiate patient evacuation manifests, identify tags, etc., and fly aeromedical airlift missions
to provide in-flight patient care.
b. Upon deployment, the MASF will provide sufficient supplies and equipment to
insure a capability to operate for five days without resupply. Units have an authorized
strength of 23 when deployed. Flight nurses, aeromedical technicians, and ground ramp
operators constitute the unit. Each MASF has a 50-patient capacity with an average
patient holding time of three to five hours. (Patients should be brought to the MASF no
sooner than four hours and not later than two hours prior to departure time of designated
aircraft.) One hundred patients per day can normally be processed and moved by each
MASF; however, a surge capability to move 150 patients per day exists.
c. The MASF staff must also establish liaison with originating medical facilities.
The liaison teams (LT), composed of the air evacuation liaison officer/NCO (AELO),
provide the initial interface between the user service and the TAES. The LT is located at
any level of the combat forces medical regulation chain of command that is required to
insure a smooth patient flow into the tactical aeromedical evacuation system.
3-30. SUMMARY
a. The patient’s attending physician makes the initial determination to evacuate a

patient to the next higher level of medical support. This determination is based on the
patient’s condition and whether or not the patient may be returned to duty within the
established evacuation policy.
MD0752 3-50
b. The patient administrator (PAD) consolidates requests from attending
physicians within the hospital and forwards these to the MRO at their next higher
headquarters (hospital centers or medical groups.)
c. Medical group MROs in the combat zone consolidate evacuation requests

from all subordinate hospitals and forwards them to the medical brigade MRO. The
medical brigade MRO consolidates all requests from the combat zone medical groups and
forwards them to the MEDCOM MRO.
d. Medical group MROs and hospital center MROs in the COMMZ consolidate
evacuation requests from their subordinate hospitals and forward these consolidated
requests to the MEDCOM MRO.
e. The MEDCOM MRO consolidates all evacuation requests from the Army
medical treatment facilities and forwards them to the TPMRC at the theater headquarters,
if the TPMRC is established.
MD0752 3-51
EXERCISES, LESSON 3
REQUIREMENT. Answer the following items by marking the lettered response that best
answers the item, by completing the statement, or by writing the answer in the space
provided at the end of the item.
After you have completed all these items, turn to “Solutions to Exercises,” at the end of
the lesson and check your answers with the Academy solutions.
1. Medical regulating is _______________________________________________

____________________________________________________________________.
2. Class XDA (2A) patients are immobile, litter patients who are unable to move about
of their own ______________________________________________________.
3. The officer of an originating, in transit, or destination MTF who coordinates

aeromedical evacuation activities of the facility is the
____________________________________________________________________.
4. Who is usually responsible for contacting the destination MTF to accept a patient in
the case of a hospital to hospital transfer?
a. Attending physician.
b. Patient evacuation clerk.
c. Flight clinic coordinator.
d. Aeromedical evacuation coordinating officer.
5. What agency is responsible for coordinating air transportation and in-flight medical
treatment for patient? ____________________________________________.
6. Transfer of a patient because an MTF lacks the capabilities or facilities to treat him
would be a transfer for _________________________________________reasons.
7. The _____________________ determines the precedence of patients being

transferred.
MD0752 3-52
8. ______________________ is the timely and efficient movement of wounded,
injured, or ill persons from the battlefield and other locations to medical treatment facilities
and from these facilities to other facilities for additional treatment.
9. Who briefs patients and attendants on the evacuation system and evacuation rules?
a. Medical attendant.
b. Attending physician.
c. Nursing service personnel.
d. Aeromedical evacuation coordinating officer.
10. The attending physician notifies the patient evacuation section of the need to
transfer a patient by sending them a :
a. DA Form 3981 (Transfer of Patient).
b. DD Form 602 (Patient Evacuation Tag.)
c. DD Form 601 (Patient Evacuation Manifest).
d. DA Form 2496 (Patient Evacuation Checklist).
11. Infants under 3 years of age occupying a seat would be a class

_____________________ patient.
12. A patient being transferred to undergo emergency surgery at another MTF would be
given a ____________________ precedence for movement.
13. What agency is responsible for selecting hospital centers or hospitals to receive
patients in an overseas theater?
_______________________________________________________________ .
MD0752 3-53
14. Psychiatric patients are assigned which precedence?
a. Urgent.
b. Routine.
c. Priority.
d. Emergency.
15. Who prepares the litters for the patients and move the patients to the evacuation
staging area?___________________________________________.
16. Who is responsible to obtain in-flight medications?
_______________________________________________________________.
17. An example of an ____________________________ reason for transfer is an

inpatient who is pending retirement due to his medical condition and is transferred to an
MTF nearest the PEB.
18. Class ________ patients require use of litters, restraint apparatus, and sedation
while in transit and at the destination. They also require close supervision at all times.
19. What agency is responsible for approving compassionate/personal or

administrative transfers?
_______________________________________________________________.
MD0752 3-54
REQUIREMENTS: Using the completed DA Form 3981 (Transfer of Patient) and the
information provided below, complete DD Form 600 (Patient’s Baggage Tag) and DD
Form 602 (Patient Evacuation Tag):
20. You are assigned to the patient evacuation section at the U.S. Army Hospital, Fort
Splendid, TX. A corpsman has just delivered the DA Form 3981 pertaining to MSG
Gordon F. Barber which contains the following information:
a. MSG Barber is scheduled for surgery at 0700, 17 Aug 9X, at Brooke Army
Medical Center. His SSN is 162064514. The originating terminal is Cactus Airport, Hole,
TX. His condition is duodenal ulcer with hemorrhage and anemia secondary to blood loss
and he is allergic to penicillin. The destination terminal is Lackland Air Force Base, TX.
b. Dr. Resident has recommended the following treatment en route:
(1) 1 unit whole blood
(2) 100 cc 5% D/W at 10 qtts/min
(3) Oxygen by nasal catheter at 8 L/min
(4) Vital signs q 15 min
(5) Endotracheal suctioning available if patient vomits
(6) Nasogastric tube to low suction.
(7) Nothing by mouth (NPO)
Check your answers
MD0752 3-55
DA Form 3981 (Transfer of Patient) for exercise 20
MD0752 3-56
DD Form 600 (Patient’s Baggage Tag) for exercise 20.
MD0752 3-57
DD Form 602 (Patient Evacuation Tag) for exercise 20
MD0752 3-58
1. A system for coordinating and controlling the movement of patients through the
various levels of health service support. (para 3-3b)
2. Volition under any circumstances. (table 3-1)
3. Aeromedical Evacuation Coordinating Officer (AECO). (para 3-9e)
4. a (para 3-14b)
5. Aeromedical Evacuation Control Center (AECC). (para 3-9d)
6. Medical. (para 3-4a)
7. Attending physician. (para 3-14d)
8. Patient Evacuation. (para 3-3a)
9. d (para 3-16e)
10. a (para 3-14a)
11. XEI (table 3-1)
12. Urgent. (para 3-14d(1))
13. Theater Patient Movement Requirements Center (TPMRC) (para 3-9b)
14. b (para 3-14d(3))
15. Nursing service personnel. (para 3-15f(3)
16. Ward nurse. (para 3-15a)
17. Administrative. (para 3-4b)
18. XA (1A) (table 3-1)
19. U.S. Army Medical Command (MEDCOM) (para 3-17c)
20. Solutions are on the next two pages.
MD0752 3-59
SOLUTIONS TO EXERCISE 20 (para 3-19):
DD Form 600 (Solution for exercise 20).
MD0752 3-60
SOLUTION TO EXERCISE 20 (para 3-20):
DD Form 602 (Solution for exercise 20).
MD0752 3-61
LESSON ASSIGNMENT
LESSON 4 Medical Services Account.
TASK TAUGHT 081-866-0087, Post DA Form 3153 (MSA Patient

Ledger Card)
4-1. Given a situation and a list of forms, select the

correct form to be used.
4-2. Given a situation, make appropriate entries on DA

Form 3153 (MSA Patient Ledger Card.)
4-3. Given a situation, complete DA Form 3154(MSA

Invoice and Receipt).
4-4. Given a situation, file DA Form 3153 in the correct

file.
4-5. Given a completed DA Form 3154, make

appropriate distribution of each copy.
SUGGESTION After studying this assignment, complete the exercises of

the lesson. These exercises will help you achieve the
lesson objectives.
MD0752 4-1
LESSON 4
MEDICAL SERVICES ACCOUNT
Section I. INTRODUCTION
4-1. INTRODUCTION
As explained in Subcourse MD0750, all patients, except newborn infants

hospitalized with their numbers and retired enlisted patients pay some portion of their
hospitalization. This lesson will explain how the medical services account (MSA) provides
for billing and collecting payment for medical care.
a. Purpose. The medical services account (MSA) is responsible for maintaining

accountability for inpatient and outpatient medical care; computing charges; submitting
billings; and processing collections, including collections by dining hall cashiers.
b. Applicability. Army regulations require MTFs worldwide to establish medical

service accounts. If the volume of medical care furnished on a reimbursable basis does
not warrant establishment of a medical services account, exception to such establishment
may be approved by the major commander. Such exception does not preclude
requirements for billing and collecting monies due and/or submitting internal and external
reports of medical care furnished.
c. Organization. In hospitals within CONUS, the MSA office is a section of the

Hospital Treasure Office, Patient Administration Division. In facilities such as U.S. Army
health clinics, the organization unit is designated MSA Offices by the MTF commander.
However, requirements for recording and collecting charges involve personnel actions in
various areas of a MTF. These areas include clinics and outpatient facilities, food service
dining halls, admission and disposition activities, and medical records and reports
activities.
4-2. RESPONSIBILITIES
a. Medical Services Accountable Officer (MSAO).
(1) The MSAO is appointed by written order of the MTF commander. The
MSAO may be a commissioned officer, a warrant officer, or a civilian employee. No one
of these is otherwise accountable for appropriated funds or government property;
however, he/she is accountable for or has custodianship of nonappropriated funds.
(2) In maintaining financial accountability for medical care furnished, the MSAO
computes charges for medical care provided eligible personnel at rates prescribed each
MD0752 4-2
fiscal year in DA Circular 40-XX-330; submits billings for those charges, including
invoices of patients and centralized billings for reimbursement at the departmental level;
processes all collections received, including payments from individuals and monies
collected for subsistence in dining halls; and trains and supervises medical services
account personnel.
(3) A commissioned officer, deputy, and assistants are not required to be

bonded. A warrant officer or civilian employee appointed as the MSAO is required to be
bonded by the Army position schedule bond.
b. Deputy Medical Services Accountable Officer. The MTF commander may

appoint by written order a deputy who must qualify under the same criteria as those
established for the MSAO. The deputy provides assistance to and assumes the duties of
the MSAO during the latter’s absence for 30 days or less. During such absence, the
MSAO retains responsibility for the actions and decisions of the deputy. For an absence
of more than 30 days, the commander appoints a replacement.
c. MSA Ledger Clerks and Cashiers. The number of medical services account
personnel varies with the patient capacity of the MTF, the locations of various activities,
and the resulting workload. Military and civilian personnel are assigned on either a part-
time or full-time basis as MSA ledger clerks, MSA cashiers, and dining hall cashiers.
Section II. MEDICAL SERVICES ACCOUNT FORMS AND FILES
4-3. FORMS
a. DA Form 3153 (MSA Patient Ledger Card). DA Form 3153 (see figure 4-1)
is used for entries concerning charges for services rendered. These include, but are not
limited to, inpatient and outpatient care and can also be used for recording charges for
administrative services provided civilian firms. The payment of these charges is also
entered on this form.
MD0752 4-3
Figure 4-1. DA Form 3153 (MSA Patient Ledger Card).
MD0752 4-4
b. DA Form 3154 (MSA Invoice and Receipt). DA Form 3154 (see figure 4-2) is
prepared in quadruplicate (copies 1, 2, 3, and 4) for interim and month-end billings for a
pay patient and as a receipt for payment. All DA Forms 3154 are prenumbered, used in
numbered sequence, and accounted for at all times.
Figure 4-2. DA Form 3154 (MSA Invoice and Receipt).
c. DA Form 3029 (MSA Accounts Receivable Register and Control Ledger).

DA Form 3929 (see figure 4-3) is used to record invoiced hospital charges and payments
or transfers of such charges to the servicing finance and accounting officer or to the U.S.
Army Medical Command. Accountability for each day’s activities is recorded by type of
transaction and by separate line item and accountability will be maintained for each
calendar month.
MD0752 4-5
MD0752
4-6
Figure 4-3. DA Form 3929 (MSA Accounts Receivable Register and Control Ledger).
d. DA Form 3155 (MSA Record). DA Form 3155 (see figure 4-4) is used to
record medical services account collections applicable to accounts receivable and cash
sales. Accountability is maintained for each day’s activities and for each calendar month
and entries include the daily undeposited balance.
Figure 4-4. DA Form 3155 (MSA Cash Record).
e. DA Form 3156 (Statement of MSA Accountable Patient Days and

Reimbursements Earned). DA Forms 3156 (see figure 4-5) is used by the MSAO to
reconcile patient days to DA Form 2789 (Medical Summary Report) and to compute
reimbursements earned for each patient category. DA Form 3156 is prepared at the end
of each month after all charges and credits have been posted to the medical service
account records.
MD0752 4-7
Figure 4-5. DA Form 3156 (Statement of MSA Accountable Patient Days
and Reimbursements Earned).
MD0752 4-8
f. DD Form 1131 (Cash Collection Voucher). DD Form 1131 (see figure 4-6) is
an accounting document used when the MSAO deposits cash collections with the servicing
finance and accounting officer.
Figure 4-6. DD Form 1131 (Cash Collection Voucher).
MD0752 4-9
g. DD Form 139 (Pay Adjustment Authorization). DD Form 139 (see figure 4-
7) is prepared for members of other DOD services and U. S. Coast Guard. This form
authorizes the collection of subsistence directly from an individual’s pay.
Figure 4-7. DD Form 139 (Pay Adjustment Authorization)
MD0752 4-10
h. SF 1080 (Voucher for Transfers Between Appropriations and/or
Funds). SF 1080 (see figure 4-8) is used to transfer funds for subsistence for enlisted
Army patients discharged during a month to the hospital account at the servicing finance
and accounting office.
Figure 4-8. SF 1080 (Voucher for Transfers Between Appropriations and/or

Funds).
MD0752 4-11
4-4. FILES
a. Active Accounts Receivable File. This is an active ledger card file containing
DA Forms 3153 (MSA Patient Ledger Card) for the following: inpatients, discharged pay
patients with balances due; outpatients granted additional time for payments of charges;
and discharged patients with paid-in-full accounts pending completion of month-end
processing. The forms are filed in any sequence that aids in preparing DA Forms 3154
(MSA Invoice and Receipt) and MSA reports.
b. Inactive Accounts Receivable File. This is an inactive ledger card file which
contains DA Forms 3153 other than those in paragraph a above. Included are ledger
cards for accounts paid in full (after completion of month-end processing) and delinquent or
uncollectible accounts transferred to the finance and accounting officer for collection. The
files are maintained in alphabetic sequence by month and retained by fiscal year.
c. Invoice and Receipt Files.
(1) Invoice suspense file. This is an alphabetic file of unpaid DA Forms 3154
(copies 3 and 4) maintained by the MSA cashier.
(2) Invoice issued file. Copy 2 of DA Forms 3154 which have been issued are
filed numerically. The file also contains each mutilated or spoiled DA form 3154 which is
interfiled as an entire set.
(3) Invoice chronological file. This file contains receipted (paid) DA Forms
3154 (copy 3) maintained by the MSA ledger clerk in alphabetic order by date.
Section III. INPATIENT LEDGER CARD PROCEDURES
4-5. INITIATION OF LEDGER CARD
a. DA Forms 3153 (MSA Ledger Card) are initiated in the Admission and
Disposition Office for each patient admitted except retired enlisted and newborn infants
hospitalized with their mothers. The DA Forms 3153 and DD Forms 139 are forwarded to
the MSA ledger clerk(s) the next morning along with the Admission and Disposition (AAD)
Report.
b. The ledger clerk reconciles the cards with the AAD Report to make sure that a
ledger card has been received for each accountable patient that was admitted or changed
to pay status (i.e., newborn infant from nonpay to pay patient).
MD0752 4-12
c. The clerk also verifies the patient information (see figure 4-9) on the forms with
the entries on the AAD Report. The form is designed for mechanically imprinted, typed, or
handwritten information to be entered. Items that should be verified are:
(1) Patient identification. Name, register number, family member prefix, and
social security number.
(2) Date of admission. Should agree with the AAD Report.
(3) Authority for admission. Applicable paragraph reference from AR 40-3 or

other authority.
(4) Patient category. For example, wife AD Army EM
(5) Invoice mailing address. This is where the invoice (DA Form 3154) may be
mailed. It may or may not be the same as the emergency addressee.
Figure 4-9. DA Form 3153 (Patient identification section).
MD0752 4-13
4-6. POSTING DA FORMS 3153
a. Patient’s Daily Hospital Record. After the reconciliation in paragraph 4-5, the
MSA ledger clerk reviews the entire AAD Report. From the transactions on the AAD
Report, the ledger clerk posts the DA Form 3153 (see figure 4-10) of patients affected. It
is at this time that the ledger clerk would insure they had received a ledger card on patients
whose status had changed from nonpay to pay patient. From the list below, the clerk posts
the appropriate control code in the box showing the day of the month and the month if it has
not been previously recorded.
Figure 4-10. DA Form 3153 (Control Codes and Patient’s Daily Hospital Record
Section).
(1) A. Admission of a patient to the medical treatment facility.
(2) B. On pass in excess of 24 hours but less than 72 hours.
(3) C. Leave authorized in writing by the facility commander.
(4) E. Absence without leave in excess of 72 hours.
(5) K. On order for temporary duty (TDY) or permanent change of station

(PCS) due to administrative action, retirement, of separation from the service for reasons
of disability.
(6) S. Subsisting elsewhere.
NOTE: Those absences in numbers (4), (5), and (6) above apply to military patients only.
Code “K” will be used again for another type of absence for nonmilitary patients.
(7) D. Discharge (disposition) from the medical treatment facility.
MD0752 4-14
(8) H. Inpatient category change. This includes change from one paying rate
to another or from nonpaying status to paying status or vice versa.
(9) R. Remaining in hospital, end-of-month. If the patient remains in the

hospital on the last day of the month (including military patients on leave), the code “R” is
posted in the date block for the last day of the month.
(10) T. Continuing hospitalization. If the patient remains in the hospital from the
previous month, the code “T” is posted in the date block for the last day of the month.
(11) K. Inpatient on a cooperative-care out.
(12) W. Inpatient on supplemental-care out. Although the patient is absent from

the hospital, these days are not days of credit.
b. Daily Rate of Charges (DA Form 3153). The amount of the rate of charges is
entered, as applicable (see figure 4-11). If the patient’s status changes (as reflected by
code “H”), the old rate is crossed out and the new rate entered (change in rate); the rate is
entered (change from nonpay to pay status); or the rate is crossed out (change from pay to
nonpay status). Rates are published each fiscal year in DA Circular 40-XX-330. (The “XX”
refers to the current FY.)
Figure 4-11. DA Form 3153 (Daily Rate of Charges Section).
c. Billing Data (DA Form 3153) (see figure 4-12).
(1) Date. Show day, month, and year of posting.
(2) Description. Enter date of admission and date of discharge.
(3) Total days. Total days of hospitalization. Include the day of admission or
change of status to pay patient and exclude the day of disposition. If the patient is
remaining on the hospital rolls as of the last day of the month, the month-end posting will
include the day of admission and all remaining days of the month.
MD0752 4-15
(4) Days credit. Show the total days of creditable absence. Include the day of
departure and exclude the day of return. If the patient has not returned by the end of the
month, the month-end posting will include as the credit the day of departure on leave plus
the remaining days of the month.
(5) Days charged. Show the remainder of total days (#3) above) minus days
credit (#4) above).
(6) Invoice or bill number. Post the number after preparing DA Form 3154.
(7) Charges, hospitalization. Compute by multiplying the days charged by the

rate of charge.
(8) Charges, other. Include any other charges which may apply, such as
charges of prosthetic devices, appliances, spectacles, or other such items which are
furnished to certain patients on a reimbursable basis.
(9) Total. Enter the sum of hospitalization plus other charges.
(10) Payment received. Post from information supplied by DA Form 3154.
(11) Balance due. Enter the remainder after deducting the payment received
from the total charges.
Figure 4-12. DA Form 3153, Billing Data Section.
MD0752 4-16
Section IV. DISPOSITION PROCESSING
4-7. ENLISTED ARMY PATIENTS
a. On the day of disposition of a patient, the MSA ledger clerk posts “D” to the
proper calendar day on the DA Form 3153 (MSA Patient Ledger Card) and computes the
chargeable days. Remember, this includes the day of admission and excludes the day of
disposition.
b. Using information from the ledger card, the ledger clerk prepares a letter to the
member’s unit. This letter informs the unit of the number of chargeable days and the
specific dates the patient was in your MTF. Figure 4-13 shows a suggested format for this
letter. The unit uses the information from your letter to prepare a DA Form 4187 to notify
the servicing finance and accounting office to collect the subsistence rate from the
member’s pay.
c. The DA Form 3153 is then held in the active accounts receivable file until month-
end processing. This is discussed in paragraph 4-12.
d. The above procedures are also followed when patient’s entire stay has been in
an absent sick or supplemental care status.
4-8. OTHER MILITARY PERSONNEL
a. On the day of disposition, the ledger clerk will post and compute the charges on
the DA Form 3153.
b. The patient will be given the option of paying the charges at that time or having
the charges deducted from his pay. If the patient chooses to pay the charges, the ledger
clerk will prepare a DA Form 3154 (MSA Invoice and Receipt), which will be covered in a
later paragraph. If the patient elects to have the charges deducted from his pay, the DD
Form 139 (Pay Adjustment Authorization) received with the ledger card on admission will
be completed and forward to the servicing finance and accounting office.
c. The DA Form 3153 is then held in the active accounts receivable file until month-
end processing.
d. Billings for Army officers admitted to civilian hospitals in absent sick status will
be sent to the officers’ military address and processed as if the officer had been in an
Army MTF.
MD0752 4-17
(use hospital letterhead)
SUBJECT: Release from Hospitalization
______________________________________________________
Name, Rank, & Serial No., Br of Svc (Act Army, USAR, NG)
TO: (Name & Address of Unit)
1. Patient was admitted _________________________________________

Date, Time
discharged ________________________________________
Date, Time
Nature of discharge:
Total days of hospitalization _______________

Number of subsistence charge days _______________
Number of authorized absence days _______________
Pass days _______________
Leave days _______________
Leave Date/time Date/time

Departure of return
_________ ________
_________ ________
2. You should have already submitted a DA Form 4187 with an absent hospital entry based on our
previous notification of hospital admission. This automatically suspended our separate rations payments to
the service member during the period of hospitalization. In order to make the necessary adjustments to the
member’s pay request, you must now submit a DA Form 4187 with all the information contained in para 1
above.
3. Questions concerning entitlements and collections for periods of hospitalization of enlisted members
should be addressed to your local Finance and Accounting Office. Further guidance is contained in JUMPS
Army LOI 84-02, dated 5 Dec 83.
FOR THE COMMANDER:
________________________
Name, Rank & Br of Svc
Position
Figure 4-13. Suggested format for letter used to prepare DA Form 4187.
MD0752 4-18
4-9. ALL OTHERS
a. As in the previously discussed patient categories, the ledger clerk will post the
ledger card and compute the charges.
b. A DA Form 3154 is prepared and processed according to paragraph 4-10 by

the MSA ledger clerk.
c. The DA Form 3153 is kept in suspense in the active accounts receivable file for
month-end processing.
4-10. DA FORM 3154 (MSA INVOICE AND RECEIPT) PROCESSING
a. Preparation. DA Forms 3154 (see figure 4-14) are prepared in quadruplicate

from information contained on DA Forms 3153. Entries on DA Forms 3154 are self-
explanatory. The information is taken directly from the DA Forms 3153.
b. Distribution.
(1) Copy 1 is given or mailed to the patient.
(2) Copy 2 is placed in the invoice issued file.
NOTE: All copies of any spoiled or mutilated DA Forms 3154 will be filed in an invoice
issue file.
(3) Copies 3 and 4 are placed in the invoice suspense file when payment is not
received at the time of issue.
(4) A total of all DA Forms 3154 issued that day are posted to DA Form 3929.
MD0752 4-19
Figure 4-14. Relationship between DA Forms 3153 and 3154.
MD0752 4-20
c. Processing Payments
(1) The patient takes copy 1 to the MSA cashier and makes payment. The
MSA cashier obtains copies 3 and 4 of DA Form 3154 from the invoice suspense file and
receipts them in one operation with the original recording on copy 1. Copy 1 is returned to
the patient as a receipt.
(2) At the end of the day, copy 3 of all receipted DA Forms 3154 is sent with an
adding machine listing of the day’s transaction to the MSA ledger clerk. Copy 4 is retained
until completion of month-end processing.
(3) The MSA ledger clerk posts the payment to the ledger card (DA Form
3153) and refiles the ledger card in the active accounts receivable file until completion of
month-end processing.
(4) Using the receipted DA Forms 3154, the MSA ledger clerk posts receipts
to DA form 3929 (Accounts Receivable Register and Control Ledger). After the posting,
copy 3 is filed in the invoice chronological file (alphabetic file).
d. When copy 1 of the DA Form 3154 is presented or mailed by the patient, the
MSA cashier removes the corresponding copies of the DA Form 3154 and follows the
procedures described in paragraph c above.
e. If payment is received without presentation of copy 1 of the DA Form 3154, the

MSA cashier removes copies 3 and 4 from the invoice suspense file and receipts these
copies in one operation. The receipted copy 4 of the DA Form 3154 is presented to or, if
requested, mailed to the remitter. Copy 3 is then retained until reconciled with the daily
collections and, supported with an adding machine control tape, is forwarded to the MSA
ledger clerk. An optional method is available if payment is made without presentation of
copy 1 of the DA Form 3154. A complete new set of DA Form 3154 may be initiated with
the appropriate cross-references made by the ledger clerk.
Section V. MONTH-END PROCESSING
4-11. REMAINING PATIENTS
a. On the first working day of each month, the MSA ledger clerk pulls all DA Forms
3153, posts code “R” to the last day of the month for remaining patients and code “T” to the
first day of the next (current) month and computes chargeable days. Included are patients
on leave who have not returned to the hospital or to duty.
MD0752 4-21
b. The total days, credit days, and days charged are determined and posted in the
billing data on DA Forms 3153. A control tape is run for the total charges on DA Forms
3153 for reconciliation with paragraph c below.
c. The MSA ledger clerk will make a one-line entry (month-end accrual) on DA
Form 3929 (MSA Accounts Receivable Register and Control Ledger) to record charges
for the previous month not yet billed. Reverse the accrual entry on DA Form 3929 the
following month.
d. The medical services account officer (MSAO) may issue interim bill for long-stay
patients prior to the patient’s disposition. Major commands are authorized to set up
criteria and give instructions to the MSAO for interim billings.
4-12. DISPOSITIONED ARMY ENLISTED PATIENTS
a. Subsistence will be billed on SF 1080 (Voucher for Transfers between

Appropriations and/or Funds) (see figure 4-15) at the end of the month for only the enlisted
members dispositioned during the month. Subsistence for those remaining will be billed at
the end of the month in which dispositioned.
b. Subsistence charges for patients remaining will be accrued in the MSA records,
but not billed. The days for which charges will accrue and the days for which charges will
be billed will be developed from the patient ledger card (DA Form 3153). For those
MEDDACs/MEDCENs operating under IAS (mechanized system), the charges will be
developed from listing produced by the system. The MSAs under the manual system will
record two entries on DA Form 3929 and DA Form 3156. One entry will be the dollar value
of rations billed. The other entry will be the dollar value of rations accrued from the date of
admission to the end of the current month but not billed. At the beginning of the following
month, the accrued but not billed entry will be reversed.
c. The SF 1080 will reflect the number of hospital chargeable days for each
enlisted patient category, e.g., enlisted AD Army, 50 days @ $3.60 per day; enlisted
National Guard, 30 days @ $3.60; enlisted Reserves, 20 days @$3.60.
d. The retained file copy of the SF 1080 for dispositioned patients will be
supported by copies of the disposition notifications (see para 4-7b). The SF 1080 will be
forwarded to the finance and accounting office not later than the third workday following the
end of the month. No supporting documentation will be attached.
MD0752 4-22
Section VI. OTHER PROCEDURES
4-13. DELINQUENT AND UNCOLLECTIBLE ACCOUNTS
Accounts are generally considered delinquent when they remain unpaid 30 days
after the date on which invoiced and when no interim payment or payment arrangements
have been made. A 30-day extension may be granted at the discretion of the MSAO.
When all efforts to collect delinquent accounts are exhausted, they are reported to the
servicing finance and accounting officer. Copies 3 and 4 of the DA Form 3154 are
removed from the invoice suspense file and forwarded with DA Form 1854 (Daily Transfer
Summary) to the finance and accounting officer. Copy 2 of DA Form 3154 is annotated
“Transferred to Finance and Accounting Officer,” dated, and refilled in the invoice issued
file.
Figure 4-15. SF 1080 (Voucher for Transfers Between

Appropriations and/or Funds).
MD0752 4-23
a. The total amount of transfers of delinquent or uncollectible accounts is posted to
DA Form 3929 in the credits column and is annotated “Transferred to Finance and
Accounting Officer.”
b. The DA Form 3153 (MSA Patient Ledger Card) is annotated “Transferred to

Finance and Accounting Officer” with the date in the payments received column and the
balance due is liquidated. It is then filed in the inactive accounts receivable file.
4-14. OUTPATIENT CHARGES
When an outpatient is given care on a reimbursable basis, DA Form 3153 is

initiated by the outpatient clerk. The ledger card is given to the patient for presentation to
the MSA ledger clerk. The MSA ledger clerk then prepares DA Form 3154 and computes
the charges. The payment and posting of the charges are handled in the same manner as
for inpatient charges. The outpatient clerk presents the MSAO with a daily listing of
patients responsible for their outpatient charges. If collection for outpatient care is handled
by centralized billing by the U.S. Army Medical Command, the ledger cards are retained
until the end of the month and then transferred on DA Form 7A to the U.S. Army Medical
Command. An alternative method allows for outpatient clinic personnel to refer pay
patients to the MSAO for payment actions. Upon return to the outpatient clinic and upon
presentation of a properly annotated DA Form 3154, the pay patient may be rendered
treatment.
4-15. SUMMARY
The medical services account (MSA) is a system to maintain accountability for

medical care, compute hospital charges, submit billings, and process collections. In
accordance with requirements established by AR 40-335 and applying worldwide, each
Army medical treatment facility commander appoints a medical services accountable
officer and, if required, a deputy. MSA ledger clerks, MSA cashiers, and dining hall
cashiers are assigned in accordance with workload requirements. The two medical
services account forms which apply to individual patient accounts are DA Form 3153
(MSA Patient ledger Card) and DA Form 3154 (MSA Invoice and Receipt). They are
maintained in the active accounts receivable file, the inactive accounts receivable file, and
the invoice and receipt files. The MSA ledger clerk maintains, files, and enters amounts of
charges on these forms and the MSA cashier collects monies and receipts for payment.
MD0752 4-24
EXERCISES, LESSON 4
REQUIREMENT. Answer the following exercises by marking the lettered response that
best answers the item, by completing the incomplete statement, or by writing the answer in
the space provided at the end of the item.
After you have completed all these items, turn to “Solutions to Exercises” at the end of
the lesson and check your answers with the solutions.
1. DA Form 3153 (MSA Patient Ledger Card) of discharged pay patients with
balances due are filed in the:
a. MSA ledger card file.
b. Inactive accounts receivable.
c. Active accounts receivable file.
d. Accounts receivable suspense file.
2. The information used to prepare DA Form 3154 (MSA Invoice and Receipt) of pay
patients is obtained from the:
a. AAD report.
b. DA Forms 3155 (MSA Cash Record).
c. DA Form 3153 (MSA Patient Ledger Card).
d. DA Form 3154 (MSA Invoice and Receipt).
3. DA Form 3153 (MSA Patient Ledger Card) is initiated for every patient admitted to
an Army MTF.
a. True.
b. False.
4. DA Form 3154 (MSA Invoice and Receipt) (copy 3) is maintained in the invoice
chronological file in ___________________ order by date.
5. The accounting document used when the MSAO deposits cash collections with the
servicing finance and accounting office is ______________.
MD0752 4-25
6. What form is used by the U.S. Coast Guard that authorizes the collection of
subsistence directly from one of its members’ pay?
a. DA Form 3153.
b. DA Form 139.
c. DD Form 1131.
d. SF Form 1080.
7. Unpaid DA Form 3154 (MSA Invoice and Receipt) (copies 3 and 4) are filed in the
invoice suspense file and maintained by the _______________.
8. The MSA ledger clerk posts the control code of ______________ to the DA Form
3153 (MSA Patient Ledger Card) of a patient on pass in excess of 24 hours but less than
72 hours.
9. DA Form 3153 (MSA Patient Ledger Card) is initiated in the admission and
disposition office for each patient admitted except:
a. SSG Jones, Training Instructor.
b. PVT Adkins, Basic Trainee.
c. SMG Bevins, Retired Sergeant.
d. MSG Payne, MSA NCOIC.
10. Mutilated or spoiled copies of DA Forms 3154 (MSA Invoice and Receipt) will be
destroyed.
a. True.
b. False.
11. MSA ledger clerks post control codes to DA Forms 3153 (MSA Patient Ledger
Card) from information on the:
a. MSA Cash Record.
b. Cash Collection Voucher.
c. MSA Invoice and Receipt.
d. Admissions and Disposition Report.
MD0752 4-26
12. __________________ is used to record invoiced hospital charges and payments,
transfers of such charges to the servicing finance and accounting office, or to the U.S. Army
Medical Command.
13. MSA personnel record medical services account collections applicable to accounts
receivable and cash sales on __________________.
14. The applicable paragraph reference from ________________ is recorded in the

“Authority for Admission/Outpatient Treatment” block of the DA Form 3153 (MSA Patient
Ledger Card).
a. AR 40-3.
b. AR 40-66.
c. AR 40-330.
d. AR 40-400.
15. The MSAO uses ________________ to reconcile patient days to the DA Form
2789 (Medical Summary Report) and to compute reimbursements earned for each patient
category.
16. An infant who appears on the AAD report under “Change of Status In” from liveborn
infant (newborn) this facility to pay patient would have a control code of
________________ posted to his DA Form 3153 (MSA Patient Ledger Card).
17. On the first working day of each month, the MSA ledger clerk pulls all DA Forms
3153 (MSA Patient Ledger Card), posts code “R” to the last day of the month for
remaining patients, and code “T” to the first day of the next (current) month.
a. True.
b. False.
Check your answers on the next page
MD0752 4-27
1. c (para 4-4a)
2. c (para 4-10a)
3. b (para 4-5a)
4. Alphabetic order by date. (para 4-4c(3))
5. DD Form 1131 (Cash Collection Voucher). (para 4-3f)
6. b (para 4-3g)
7. MSA cashier (para 4-4c(1))
8. B (para 4-6a(2))
9. c (para 4-5a)
10. b (para 4-10b(2))
11. d (para 4-6a)
12. DA Form 3929 (MSA Accounts Receivable Register and Control Ledger).
(para 4-3c)
13. DA Form 3155 (MSA Cash Record). (para 4-3d)
14. a (para 4-5c(3))
15. DA Form 3156 (Statement of MSA Accountable Patient Days and

Reimbursements Earned). (para 4-3e)
16. h (para 4-6a(8))
17. a (para 4-11a)
MD0752 4-28
LESSON ASSIGNMENT
LESSON 5 Patients’ Trust Fund.
TASKS TAUGHT * 081-866-0022, Complete DA Form 3696 (Patient’s

Deposit Record).
* 081-866-0123, Forward Funds and Valuables after
the Disposition or Transfer of a Patient.
* 081-866-0124, Make Disposition of the Funds and
Valuables of a Mentally Incompetent Patient.
LESSON OBJECTIVES After competing this lesson, you should be able to:
5-1 Identify the purpose of the Patients’ Trust Fund.
5-2 Identify the levels of responsibility for the Patients’

Trust Fund.
5-3 Given a situation, list procedures for forwarding

Funds and valuables left on deposit in the Patients’
Trust Fund.
5-4 Identify who may be designated as custodian of

the Patients’ Trust Fund.
5-5 Given a situation, list operating principles

governing a Patients’ Trust Fund.
5-6 Given a list of items, identify those that may be

deposited in the Patients’ Trust Fund as funds, those
that may be deposited as valuables, and those not
acceptable for deposit.
5-7 Given a situation and a transaction, identify the

information for DA Form 3696.
5-8 Given a situation and a transaction, identify the

information for DA Form 3983.
SUGGESTION After studying this assignment, complete the exercises

of the lesson. These exercises will help you achieve
the lesson objective.
MD0752 5-1
LESSON 5
PATIENT’S TRUST FUND
Section I. INTRODUCTION AND PRINCIPLES
5-1. INTRODUCTION
a. Purpose. The purpose of the Patients’ Trust Fund (PTF) in an Army hospital is
to safeguard, account for, and provide administrative control of patients’ funds and
valuables. When a patient is admitted, he is informed by the admitting clerk that funds and
valuables may be deposited and that the hospital will not assume liability or responsibility
for items kept in the patient’s possession.
b. Definitions. The meanings of the following terms are essential to an

understanding and working knowledge of the procedures for administering the PTF:
(1) Custodian. The person responsible for the receipt, safekeeping

disbursement, and accounting for patients’ funds and valuables deposited with the fund.
(2) Funds. The term “funds” includes all domestic currency and coins, and
four kinds of checks (cashier’s checks, traveler’s checks, checks drawn on the “Treasurer
of the United States,” and checks drawn on another PTF when accepted for deposit).
(3) Patient’s Trust Fund. Facilities and activities organized as a unit of the
Patient Accountability Branch, Patient Administration Division, to safeguard and account
for funds and valuables owned and deposited by patients admitted to an Army hospital in
the continental United States. In a hospital located outside the continental United States,
procedures to establish a PTF may be adopted at the discretion of the major commander
having jurisdiction over the hospital.
(4) Responsible individual. An individual who is responsible for transactions

relative to deposits in the PTF when the patient is unable to deposit directly with the
custodian or assistant custodian.
(5) Intermediate individual. An individual within each professional

department or service who is charged with specific responsibility for all transactions
between patients who have established an account with the PTF and the custodian of the
PTF that require the services of an intermediate recipient.
MD0752 5-2
(6) Valuables. The term “valuables” includes all negotiable and
nonnegotiable instruments not classified as “funds.” Personal checks, credit cards,
valuable papers, jewelry, watches, rings, billfolds, foreign coins or currency, and items
such as expensive cameras and binoculars all are classified as “valuables.” If the patient is
the sole indorser on a negotiable instrument made payment to him, he may, if he so
desires, strike his indorsement, thus rendering the instrument nonnegotiable while it is in
the custody of the fund custodian.
5-2. RESPONSIBILITIES
a. Commander. The hospital commander has the overall responsibility to:
(1) Operate the PTF.
(2) Properly safeguard patients’ funds and valuables.
(3) Designate in writing an officer, warrant officer, or civilian employee as

custodian of the PTF.
(4) Designate in writing additional individuals as required for the efficient

operation of the PTF to include alternate or assistant custodian, cashiers, bookkeeper,
responsible and intermediate individuals.
(5) Determine the amount of cash to be kept on hand in the change fund and
notify the custodian in writing of the amount authorized to satisfy the day-to-day demands
for withdrawals of funds.
b. Custodian. The custodian of the PTF has the responsibilities to:
(1) Receive, safeguard, disburse, and account for patients’ funds and valuables
deposited with the fund.
(2) If absent in excess of 30 days, transfer accountability to a replacement

custodian who will accept and receipt for the patients’ funds and valuables.
5-3. ITEMS AND SERVICES EXCLUDED FROM PATIENTS’ TRUST FUND
Items other than funds and valuables are not accepted for deposit with the PTF and
the fund is not allowed to be used for certain other services. Excluded items and services
are as follows:
MD0752 5-3
a. Items Excluded.
(1) Personal firearms, other weapons, including pocket knives with blades
beyond the length permitted by law or regulations, and any other items or objects which
could be considered a menace to safety or health are receipted for and turned over to the
Commander, Medical Holding Unit, or other responsible officer for safekeeping and
disposition.
(2) Funds and valuables for individuals not in patient status. The PTF is not
used for the safeguards or funds and valuables belonging to individuals not in an inpatient
status.
b. Services Excluded.
(1) Investments or loans. No investments or loans may be made with funds

on deposit.
(2) Donations or contributions. Donations or contributions cannot be made

or received by the fund.
(3) Cashing checks. Under no circumstances can money deposited in the

PTF be used for the purposes of cashing checks. Cashier’s checks, traveler’s checks,
checks drawn on the “Treasurer of the United States,” and checks drawn on another PTF
will not be cashed but are accepted for deposit as cash if properly indorsed. Checks other
than the above are not accepted for deposit as cash.
5-4. OPERATING PRINCIPLES
a. Disbursements. Disbursements are made by check whenever practicable.

They are made only to a patient who is a depositor (whether or not he is physically able to
sign the necessary forms) except as follows:
(1) A disbursement may be made to the intermediate individual upon written

authorization of the patient depositor.
(2) A check may be drawn payable to the individual assuming custody of a

mentally incompetent patient upon discharge.
(3) A check may be drawn payable to the custodian of a PTF for a cash on
hand reimbursement.
(4) A check may be drawn payable to the “Treasurer of the United States” for
transfer of unclaimed money or overages.
MD0752 5-4
b. Subfunds. In those hospitals where various elements are located separately
or at considerable distance from one another, the commander may authorize the operation
of a separate subfund. The custodian of the PTF retains responsibility for its operation.
The custodian will authorize the transfer of applicable deposit records and establish a
change fund. Periodically, a summary of all receipts and disbursements and cash on hand
is prepared and posted to the Patients’ Trust Fund Journal (covered in detail in later
paragraphs).
c. Shortages in Funds or Losses of Property. Shortages in funds or losses of

property are promptly investigated. The investigation is done in accordance with AR 15-6.
When losses of funds are not recoverable and it is determined that there was no fraud,
dishonesty, or willful misconduct associated with the loss and no one is held pecuniarily
liable, the fund is constructively liquidated and a claim or claims initiated against the
Government.
d. Unclaimed Monies and Overages. If a patient departs from the hospital

without withdrawing his funds and valuables, action is taken to dispose of these items as
follows:
(1) Forwarding address known. A check is drawn to the order of the patient
for the funds left on deposit and is forwarded to the patient with a letter of transmittal to his
new address within one working day after the patient’s departure. A copy of the letter of
transmittal is filed with the PTF records. Valuables are sent by first class registered mail,
return receipt requested. When valuables are forwarded, two additional copies of the
inventory are included with the letter of transmittal with a request that one copy of the
inventory be receipted and returned. Receipts and a copy of the transmittal are filed with
PTF records.
(2) Forwarding address unknown. A letter requesting the current address of

a former patient is prepared. The letter includes a detailed report of all pertinent
circumstances. This letter is coordinated with the AG and MILPO in the attempt to locate
the former patient. When the correct address is received, funds, and valuables are
processed in accordance with paragraph (1) above. If the patient cannot be located, an
attempt is made to locate the next-of-kin. If the location of the individual cannot be
determined, the monies left on deposit are deposited with the local finance and accounting
officer. A check in the amount of the deposit is drawn payable to the “Treasurer of the
United States” and forwarded to the finance and accounting officer for deposit in the trust
fund “Unclaimed Monies of Individuals Whose Whereabouts Are Unknown” together with a
letter containing all known details and a request that a receipt be furnished.
(3) Overages. When overages are discovered in the PTF and verified by
audit, a check is drawn payable to the “Treasurer of the United States” and forward to the
local finance and accounting officer for deposit in account “Forfeitures of Unclaimed Money
and Property.”
MD0752 5-5
e. Transfer of Custodians. When a custodian is relieved and a successor
custodian designated, transfer or accountability must be accomplished.
(1) Joint inventory. The retiring custodian will close and balance all records,
prepare a bank reconciliation to show both the bank and journal balances as well as the
outstanding checks, and count the cash on hand. The successor custodian will verify this
information.
(2) The joint statements (see figure 5-1) are prepared in quadruplicate and
all copies signed by the appropriate custodian. Records, keys, cash valuables, etc. are
turned over to the succeeding custodian who signs all copies of the appropriate statement
after verifying that no discrepancy exists.
Statement of Outgoing Custodian Statement of New Custodian
I have, this ___ day of ______ 19__, transferred to I have, this _____day of ______ 19___, received from
__________ , the new custodian, $____________ cash _________ , the sum of $____________ presenting the balance
Patients Trust Fund in _________________________ due patients, together with valuables listed on the individual
(Name of Bank) patients’ deposit records, and I hereby relieve him from all
__________and all items listed on Patients’ deposit records. responsibility for the Patients’ Trust Fund.
(Signature) (Signature)
(Grade and SSN) (Grade and SSN)
Figure 5-1. Statements of outgoing and new custodians.
(3) New combination/lock for security container. When a safe is provided for
the use of the custodian, the combination is changed upon transfer of funds and valuables
to a successor custodian.
(4) New authorization signature cards. When the actual transfer of the PTF is
accomplished, the original of the above statements and a signature card bearing the
signature of the new custodian are forwarded to the hospital commander. The hospital
commander gives written notice of the change to the local bank and encloses the signature
card of the new custodian. The three remaining copies of the custodians’ statements are
distributed to the outgoing custodian, the new custodian, and the files of the PTF.
MD0752 5-6
5-5. SAFEGUARDING FUNDS AND VALUABLES
The custodian will maintain positive control over all funds and valuables to ensure
that accountability may be established to a designated individual at all times.
When funds or valuables are transferred from one individual to another, receipts must be
used.
a. Bank Deposits. Cash receipts above the amount authorized to be retained on

hand in the change fund are deposited promptly in a local bank except as provided in
paragraph (2) below. All funds deposited in the bank are placed in the checking account.
(1) Funds are deposited to the credit of the “Patients’ Trust Fund Account.”
In addition the official designation of the fund, the name of the account will include the
words “an instrumentality of the United States.” Monies which do not pertain to the PTF are
not deposited in this account.
(2) At smaller hospitals where the total amount of money available for
deposit is insufficient to preclude the payment of bank service charges, funds are not
deposited in a bank unless the custodian secures assurance from the bank that the service
charge is waived.
b. Valuables. Valuables are placed in a safe or other container or room which

provides the same degree of protection as a safe.
(1) A physical description of the valuable, NOT qualitative judgment is

made. Serial numbers, brand names, and markings/inscriptions are noted.
(2) When possible, the valuables are placed in a sealed envelope with the
patient’s name and PTF account (register) number written on the envelope.
(3) The safe or security container is placed in a location or room which can
be secured.
Section II. FORMS AND TRANSACTIONS
5-6. FORMS
a. DA Form 3696 (Patient’s Deposit Record). This form is prepared in

duplicate at the time a patient initially wishes to deposit his funds or valuables, usually at
the time of admission to the hospital.
(1) The top of the form (see figure 5-2) is used to enter the patient’s
identification, including the patient’s register number. The register number serves as the
individual account number for the patient for PTF transactions. Columns are used to make
MD0752 5-7
entries for fund transactions. Each transaction requires the date of transaction; amount of
deposit or amount of withdrawal; and the signature of the person receiving the deposit or
the funds withdrawal. The first signature block on the form is signed by the patient to
indicate that he does or does not wish to make a deposit and/or to indicate that he has
been informed that any possessions which he does not deposit are retained at his own
risk. The second signature block at the top of the form is for use when all funds and
valuables are withdrawn and the account is closed, i.e., prior to the patient’s departure
from the hospital.
(2) The bottom of the form (see figure 5-2) is used to list valuables deposited.
The information entered includes: number (quantity of like items); description; date and
signature of custodian when deposit is made; and date and signature of patient or
responsible individual when a withdrawal is made. For articles of intrinsic value, the
description is made without an attempt to evaluate it; for example, “ring, silver color with
clear stone” is used as a description instead of “silver ring with diamond stone.” If an
article has a serial number, the serial number is included in the description if it can be
seen without dismantling the article. Valuables are kept in sealed containers such as
envelopes, cloth bags, or appropriate containers. The containers are clearly marked with
the patient’s name and account (register) number and are numbered (e.g., “No. 1 of 1,”
“No. 1 of 2,” “No. 2 of 2,” etc.) Valuables too large to be inserted in an envelope may be
kept in any appropriate container, properly labeled, or wrapped and tagged with a DD
Form 599 (see figure 5-3).
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Figure 5-2. DA Form 3696 (Patient’s Deposit Record).
MD0752 5-9
Figure 5-3. DD Form 599 (Patient’s Effects Storage Tag).
(3) When the space provided on the deposit record is not adequate for all
transactions, an additional copy of the deposit record is prepared in the usual manner,
clearly marked “No. 2 of 2” of the equivalent, and stapled to the original DA Form 3696.
MD0752 5-10
b. DA Form 3983 (Patients’ Trust Fund - Authorization for Deposit or
Withdrawal of Funds and Valuables). See figure 5-4.
(1) General. This form is prepared in duplicate for every deposit or

withdrawal of funds and valuables (other than the initial deposit) requiring the services of an
intermediate recipient except where the Military Payroll Money List is used for deposits or
a roster of patients is used for purchase of comfort items.
(2) Withdrawals. When the patient is physically unable to go to the

custodian’s office to make a withdrawal, DA Form 3983 is prepared in duplicate and
signed by the patient. The duplicate is retained by the patient. The original, together with
the patient’s copy of the deposit record, are presented to the custodian by the
intermediate individual for payment. The custodian verifies the patient’s signature on the
DA form 3983 and makes the proper entries on both copies of the deposit record. The
intermediate individual signs both copies of the deposit record and returns the money or
valuables, together with the patient’s copy of the deposit record, to the patient. The
intermediate individual signs for money or valuables on the original DA Form 3983 which is
returned by the custodian. The duplicate DA Form 3983 is signed by the patient upon
delivery of the money or valuables and given to the intermediate individual as his receipt.
When a patient is physically unable to sign the necessary forms, the above procedure is
followed except that the signature of a witness is secured in lieu of that patient.
(3) Deposits. When the patient is physically unable to go to the custodian’s

office, DA Form 3983 is prepared in duplicate and both copies are signed by the patient.
The duplicate is signed by the intermediate individual and retained by the patient until the
transaction is completed. The original, together with the additional funds and/or valuables
and the patient’s copy of the deposit record, are taken to the custodian by the intermediate
individual. The custodian makes the appropriate entries on both copies of the deposit
card, signs both copies, and returns the patient’s copy to the intermediate individual for
delivery to the patient. The original DA Form 3983 is retained by the custodian; the
duplicate is returned to the intermediate individual by the patient upon delivery of his copy
of the deposit record. When the patient’s signature cannot be obtained, DA Form 3696 or
DA Form 3982, as appropriate, is signed by a witness as described for a withdrawal.
MD0752 5-11
Figure 5-4. DA Form 3983 (Patients’ Trust Fund - Authorization for Deposit or
Withdrawal of Funds and Valuables).
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5-7. TRANSACTIONS
a. Initial Deposits.
(1) At the time of admission, the admissions clerk informs the patient that the
Patients’ Trust Fund in available for the deposit of funds and/or valuables and that the
hospital does not assume liability or responsibility for items kept in the patient’s
possession. If the patient does not wish to make a deposit, he signs the first signature
block at the top of DA Form 3696 which is retained by the custodian. If the patient wishes
to make a deposit, the following procedures are followed:
(a) The admitting clerk prepares DA Form 3696 in duplicate.
(b) The patient takes both copies of DA Form 3696 to the custodian who
enters a description of the funds and/or valuables and deposits them.
(c) The patient signs the block that he desires to make a deposit and the
custodian signs that he has received the funds and valuables on both copies. The original
is retained by the custodian and the duplicate is given to the patient as his receipt.
(2) When the deposit cannot be handled as a direct transaction between the
patient and the custodian, the deposit record (DA Form 3696) is prepared in triplicate by
the admitting clerk and all copies are signed by the patient. The responsible individual
receipts for the deposit on the triplicate copy of the deposit record and gives it to the
patient or forwards it to the intermediate individual of the professional service to which the
patient is assigned. The original and duplicate copies of the deposit record, together with
the funds and/or valuables, are taken to the custodian by the responsible individual for
deposit. The custodian checks the funds and/or valuables against the entries on the
deposit record. If the entries are correct, the custodian signs both copies of the form. The
original of the deposit is retained by the custodian and the duplicate is returned to the
responsible individual as his receipt.
(3) When the patient’s signature cannot be obtained because he is unconscious

or otherwise physically unable to sign the deposit record (i.e., blind or arm amputee) or
when closed ward neuropsychiatric patients and patients under restraint for medical
reasons refuse to cooperate in the preparation of the deposit record, the above
procedures are followed except that an officer or other responsible person (in the case of a
nonmilitary patient, the sponsor or next-of-kin (NOK), if present) witness the transaction
and signs all copies of the deposit record. If necessary, the patient is searched in the
presence of a witness. A brief statement on why the patient’s signature was not obtained
(e.g., “unconscious,” “NP patient,” etc.) is entered on the custodians’ copy of the deposit
record. For nonmilitary patients, written acknowledgement is obtained on the custodian’s
copy of the deposit record from the patient as soon as he is able to respond or, in the
event he continues to be incapable of signing, the sponsor or NOK in his behalf. The
MD0752 5-13
patient’s copy of the deposit record for these patients is not released to the patient but is
retained by the intermediate individual.
b. Subsequent Deposits.
(1) When the patient wishes to make additional deposits of funds or valuables, he
presents his copy of the deposit record to the custodian with the funds and/or valuables.
The custodian itemizes and enters the amount of funds and/or valuables together with the
date of deposit on both his and the patient’s copy of the deposit record. The custodian
signs both copies and returns the patient’s copy to the patient.
(2) When the patient is physically unable to go to the custodian’s office, the
procedures outline in paragraph 5-6b (2) are used.
(3) When the patient’s signature cannot be obtained, DA Form 3696 or DA Form
3983, as aappropriate, is signed by a witness as described in paragraph 5-6b(2).
c. Partial Withdrawals.
(1) When a patient wishes to make a partial withdrawal of funds or

valuables, he presents his copy of the deposit record to the custodian who makes the
proper entries on both copies of the deposit record. The patient signs both copies to
receipt for the withdrawal. The custodian requires proper identification and ascertains that
the signature is authentic. The patient retains his copy of the deposit record.
(2) When the patient is physically unable to go to the custodian’s office, the
procedures outlined in paragraph 5-6b(2) are used.
(3) When a patient wishes to make a partial withdrawal but is physically unable to
sign the necessary forms, one of the above procedures is followed except that the
signature of a witness is secured in lieu of that of the patient.
(4) The preferred method of handling partial withdrawals of funds or valuables by

closed ward neuropsychiatric patients and patients under restraint for medical reasons is a
direct transaction between the patient and the custodian. When this is not practical, the
procedure using an intermediate individual is followed. However, no partial withdrawals by
patients in this category are permitted unless the patient acknowledges receipt with his
signature.
(5) No partial withdrawals are made from deposits of patients who have been
declared mentally incompetent.
MD0752 5-14
d. Withdrawals in Full.
(1) Withdrawals in full are handled in the same manner as partial withdrawals except
that the patient signs the custodian’s copy of the deposit record in the block headed
“Funds and Valuables Received in Full” at the top of the form. After a patient has
withdrawn all funds and valuables and the account has been closed, the patient’s copy of
the deposit record is destroyed immediately.
(2) When the patient is physically unable to go to the custodian’s office, withdrawals
in full are handled in the same manner as partial withdrawals except that the intermediate
individual signs the custodian’s copy of the deposit record in the block marked “Funds and
Valuables Received in Full” at the top of the form.
(3) When the patient is physically unable to sign the required forms for withdrawal,
the above procedures are followed except that the signature of a witness is secured in lieu
of the patient’s.
(4) The preferred method of handling withdrawals in full by closed ward

neuropsychiatric patients and patients under restraint for medical reasons is a direct
transaction between the patient and the custodian. When this is not practical, the
procedure in paragraph (2) above is followed. When the patient is unable to comprehend,
the funds and/or valuables are disposed of in the manner prescribed in paragraph f. If the
patient is able to comprehend but refuses to sign DA Form 3696 or DA Form 3983 and is
discharged or transferred, the funds and/or valuables are disposed of in the manner
prescribed in paragraph g.
e. Disposition of Deposits of Patients Transferred to Community Nursing

Homes. Funds and valuables of patients transferred to a community nursing home under
VA contract are shipped by the military unit commander to the patient’s home or other
location designated by the patient prior to transfer of the patient.
f. Disposition of Deposits of Mentally Incompetent Patients.
(1) When a patient declared to be mentally incompetent is discharged or

transferred, his funds and valuables are disposed of in accordance with one of the
following paragraphs (listed in order of priority):
(a) When a legal committee, guardian, or other representative is appointed by

a court of competent jurisdiction, the funds and valuables are turned over to such
committee, guardian, or representative.
(b) When paragraph (a) above cannot be followed, the funds and valuables are
turned over to the NOK. The NOK determination is done in accordance with the law of the
state in which the personal property is located. If the patient is not subject to
MD0752 5-15
military law, disposition of the property to the NOK requires notification to local authorities
responsible for the disposition of nonmilitary psychotic patients prior to the disposition.
(2) On the day of departure of the patient, the custodian makes and signs an
inventory in duplicate of the patient’s funds and valuables on deposit in the patient trust
fund. A check for any money on deposit is drawn payable to the appropriate individual
assuming custody. The check will have plainly written on the face thereon “Credit Account
of (Name of patient).”
(3) The check and a copy of the inventory listing the patient’s valuables, together
with the valuables, are turned over to the individual assuming custody and the individual’s
signature is secured on one copy of the inventory for the records of the PTF. When funds
and valuables of the patient cannot be turned over directly to the individual assuming
custody, the funds and valuables are forwarded to the individual assuming custody of the
patient in the manner described in the following paragraphs.
g. Deposits Remaining After Disposition or Transfer of Patients. Usually, the

patient withdraws funds and valuables on deposit with the PTF prior to departure from the
hospital. Funds and valuables remaining on deposit after the departure of a patient are
disposed of as follows:
(1) Forwarding address known. A check is drawn to the order of the patient for the
funds left on deposit. The check and a letter of transmittal is forwarded to the patient at his
new address within one working day after the patient’s departure. A copy of the letter of
transmittal is filed with PTF records. Valuables are sent by first class registered mail,
return receipt requested. When valuables are forwarded, two additional copies of the
inventory are included with the letter of transmittal with a request that one copy of the
inventory be receipted and returned. Receipts and a copy of the transmittal letter are filed
with PTF records.
(2) Forwarding address unknown. A letter requesting the current address of the
former patient is prepared, to include a detailed report of all pertinent circumstances, and
forwarded to the Commander, US Army Enlisted Records and Evaluation Center, ATTN:
PCRE-FM, Fort Benjamin Harrison, IN 46249, for enlisted personnel and to HQDA
(DAPC-PSR-SR), 200 Stovall Street, Alexandria, VA 22332, for officer personnel. Upon
receipt of the necessary information, the funds and valuables are processed in
accordance with paragraph (1) above. If this correspondence fails to locate the service
member, an attempt to locate the NOK through the Veterans Administration or the Red
Cross is made. If the individual cannot be located, the monies left on deposit are
deposited with the local finance and accounting officer in the manner prescribed for
outstanding checks covered in a later paragraph. DOD 4160.21-M provides disposition
instructions for valuables.
MD0752 5-16
(3) Deposits of deceased patients. Funds and valuables left on deposit by
patients who have died are disposed of in conformance with AR 638-1.
5-8. ACCOUNTING FOR FUNDS
The procedures outline in the following paragraphs are applicable primarily to those
MTF having a relatively large volume of transactions. Local modifications are made to suit
the requirements of individual facilities. These modifications require the approval of the
MTF commander and must comply with the intent of this regulation.
a. Summary of Deposits and Withdrawals. At the close of business each day, a

summary of deposits and withdrawals is prepared DA Form 4665-R (Patients’ Trust Fund -
Daily Summary Record) (see figure 5-5) which is reproduced locally. Each transaction
involving a deposit or withdrawal from the PTF is posted separately to the summary
showing the patient’s name, the register number, the amount of deposit or withdrawal,
and a breakdown by cash or check. Totals from the summary are entered daily on DA
Form 4128 (Patients’ Trust Fund Journal).
b. DA Form 4128 (Patients’ Trust Fund Journal). This journal (see figure 5-6)
contains a daily summary of all money transactions with the PTF. Detailed entries of
money transactions and deposits or withdrawals of valuables are entered in this journal.
(1) General. The following instructions are used in maintaining the journal.
(a) Column a. Enter the date of entry.
(b) Column b. Enter the total amount of receipts for the day.
(c) Column c. Enter the total amount of cash disbursements for the day.
(d) Column d. Enter the total amount of check disbursements for the day.
MD0752 5-17
Figure 5-5. DA Form 4665-R (Patients’ Trust Fund–Daily Summary Record)
(continued).
MD0752 5-18
Figure 5-5. DA Form 4665-R (Patients’ Trust Fund - Daily Summary Record (concluded).
MD0752 5-19
(e) Column e. Enter the sum of columns c and d.
(f) Column f. To the previous day’s balance, add the receipts shown in
column b, deduct the withdrawals shown in column e, and enter the result. At the
beginning of each month, the initial entry is the fund balance brought forward from the last
day of the preceding month.
(g) Column g. To the previous day’s balance, add the receipts shown in
column b, deduct the cash withdrawals shown in column c, and enter the result except
when it exceeds the authorized amount of the change fund. (NOTE: The change fund is the
amount of cash the commander authorizes to be on hand). If the result exceeds the
authorized amount of the change fund, enter the authorized amount of the change fund and
record the difference between cash on hand and the authorized amount of the change fund
“for deposit” in column h. At the beginning of each month, the initial entry is the change
fund balance brought forward from the last day of the preceding month.
(h) Column h. Enter the amount for deposit as computed in column g.

Amount may be accumulated until a deposit is made.
(i) Column I. Enter the number of the checks drawn to bring the change fund
up to the authorized amount.
(j) Column j. When the change fund falls below the authorized amount, a
check is drawn to bring the change fund up to the authorized amount. The amount of the
check is entered in this column.
(k) Column k. Enter the sum of columns g and h or j, as applicable.
(l) Column l. Enter the bank balance per checkbook. At the beginning of the
month, the initial entry is the bank balance brought forward from the last day of the
preceding month.
MD0752 5-20
MD0752
5-21
Figure 5-6. DA Form 4128 (Patients’ Trust Fund Journal).
(m) Column m. Enter the sum of columns k and l. This figure should
balance with the figures shown in column f. At the beginning of each month, the initial entry
is the total fund balance brought forward from the last day of the preceding month.
(n) Column n. Enter any pertinent remarks in this column.
(2) Trial balance. At the end of the month, the custodian prepares a trial
balance of all open accounts in the Patients’ Trust Fund. The trial balance consists of the
patient’s full name or account (register) number and the balance in the account. When the
trial balance is prepared, it is checked to determine whether patients have departed who
are on the trial balance. Funds and valuables of patients found to have departed the MTF
are disposed of in accordance with paragraph 5-7g.
(3) Verification of balances. Periodically, the balances of the individual

patients’ deposit records are added and reconciled to the balance shown in the journal.
The total bank balance plus the cash on hand should be equal at all times to the amount
shown on the patients’ deposit records.
c. Checkbook. A checkbook is maintained by the custodian. All checks are

numbered serially. This is done by pen and ink or by a numbering machine. Such process
is accomplished immediately upon receipt of each new book of checks. Every
disbursement by check is entered in the checkbook and the stub is completely filled out.
Deposits from cash receipts are entered on the appropriate stub and a running balance is
maintained. Cancelled checks returned from the bank with the monthly statement are filed
in numerical order. Voided checks are marked “VOID,” countersigned by the custodian,
and filed in numerical sequence with cancelled checks. Each individual check has the
following stamped statement on the reverse: “THIS CHECK IS NOT VALID UNLESS
PRESENTED FOR PAYMENT WITHIN 12 MONTHS FROM DATE OF ISSUE.”
d. Bank Account.
(1) Deposit slips. Duplicate deposit slips are filed in the PTF for each
deposit.
(2) Reconciliation of bank statement. At the end of each month, the bank
statement is reconciled and balanced to the journal, the checkbook, and the cash on
hand.
(3) Outstanding checks. At the end of each month, the custodian

determines from the bank reconciliation which checks have been outstanding for 12
months or longer from the date of issue. The custodian makes all reasonable efforts to
locate the payee. Failing to locate the payee, the custodian sends a letter, in duplicate, to
the bank requesting stop payment on the check and requesting that the copy of the letter be
returned with a notation reflecting the date such stop payment was effected. When this
MD0752 5-22
notice is received from the bank. the amount of the check is entered in the checkbook as a
receipt with appropriate explanation on the stub and included in the entry of total receipts
for the day (column b) in the journal with an appropriate explanation in column n. A check in
the same amount is then drawn payable to the “Treasurer of the United States” and
forwarded to the local finance and accounting officer for deposit in the trust fund account
called “Unclaimed Monies of individuals Whose Whereabouts are Unknown (Name of
Individual)” together with a letter containing all known details and a request for receipt.
This check is included in the entry of total check disbursement for the day (column d ) in the
journal with an appropriate notation entered in the “Remarks” column. When the receipt is
received from the finance and accounting officer, it is attached to the copy of the stop
payment letter and made a part of the files of the PTF.
e. Overages. When an overage in the fund in verified by audit, a check is drawn

payable to the “Treasure of the Unite States” and forwarded to the local finance and
accounting officer for deposit in the receipt account “Forfeitures of unclaimed Money or
Property.”
5-9. ACCOUNTING FOR VALUABLES
a. Transactions. The deposit and withdrawal of valuables are posted to the

valuables portion of the patient’s deposit record, DA Form 3696. Each item deposited is
accounted for individually. For numerous items of similar nature and of little value such as
several small denomination foreign coins, a group remark such as “foreign coins--5” may
be used. When a valuable time has a serial number which is evident without dismantling,
the number is entered on the deposit record. For articles of considerable intrinsic value
such as cameras, watches, jewelry, or rings, an appropriate description is recorded on
the deposit record to assist in identification of the item. As stated in an earlier paragraph,
describe the article without attempting to evaluate it.
b. Additional Deposit Records. When the space provided on the

deposit record is inadequate for subsequent transactions, an additional copy of the
deposit record is prepared in the usual manner but is clearly marked “No. 2 of 2” or the
equivalent and stapled to the original.
c. Storage. Valuables are kept in sealed containers such as envelopes, cloth

bags, or other appropriate containers. These containers are clearly marked with the
patient’s name and account (register) number. All containers are numbered (e.g., “No.1 of
1, ” “No. 1 of 2,” “No. 2 of 2,” etc.). Valuables may also be wrapped and tagged with DD
Form 599 (Patient’s Effects Storage Tag).
MD0752 5-23
5-10. AUDIT
The Patients’ Trust Fund is audited annually and at any other time that the MTF
commander determines it appropriate. The audit is performed in accordance with AR 36-
75.
5-11. SUMMARY
When a patient is admitted to an Army hospital, he is offered the opportunity to

safeguard his funds and valuables by depositing them in the Patients’ Trust Fund which is
an organizational unit of the hospital treasurer office, patient accountability branch, patient
administration division. The patient is informed that the hospital assumes no liability or
responsibility for items which are kept in the patient’s possession. The custodian of the
Patients’ Trust Fund is an officer, warrant officer, or civilian employee appointed by the
hospital commander. A patient may make an initial deposit upon admission, subsequent
deposits, and partial withdrawals during hospitalization and final withdrawal prior to his
departure from the hospital. Whenever possible, the procedures are a matter of direct
transaction between the patient and the custodian. If an intermediate recipient is needed
because the patient is unable to go to the custodian’s office, the services of the
responsible individual (initial deposit) or intermediate individual (subsequent deposits and
withdrawals) are available. A witness, next-of-kin, or legal representative may sign for a
patient who is unconscious, mentally incompetent, or physically unable to sign
authorization forms. Operating procedures are provided in accounting for funds and in
providing protective storage for valuables.
MD0752 5-24
EXERCISES, LESSON 5
REQUIREMENT. Answer the following items by marking the lettered response that best
answers the item, by completing the statement, or by writing the answer in the space
provided at the end of the item. After you have completed all these items, turn to “Solutions
to Exercises” at the end of the lesson and check your answers with the Academy solutions.
1. When an overage is discovered in the Patients’ Trust Fund, what action is taken?
2. What is the name of the account in a local bank for the Patients’ Trust Fund?
3. What information is entered in column b of DA Form 4128?
4. Name three items that are excluded from the Patients’ Trust Fund.
a.________________________________________________________
b.________________________________________________________
c,________________________________________________________
5. What is the purpose of the Patients’ Trust Fund in an Army hospital?
__________________________________________________________
__________________________________________________________
MD0752 5-25
6. How often is the trial balance prepared for the Patients’ Trust Fund?
a. Daily.
b. Weekly.
c. Monthly.
d. As required.
7. When is a witness required to sign the DA Form 3983 (Patients’ Trust Fund -
Authorization for Deposit or Withdrawal of Funds and Valuables)?
__________________________________________________________
8. What information is entered in column e of DA Form 4128 (Patients’ Trust Fund

Journal)?
__________________________________________________________
9. Who maintains the checkbook for the Patients’ Trust Fund?
__________________________________________________________
10. When a patient deposits valuables in the Patients’ Trust Fund, the valuable is
usually placed in a sealed envelope. How is the envelope identified?
__________________________________________________________
11. Name three services excluded from the Patients’ Trust Fund.
a._________________________________________________________
b._________________________________________________________
c,_________________________________________________________
MD0752 5-26
12. List four examples that are considered valuables in the Patients’ Trust Fund.
a._________________________________________________________
b._________________________________________________________
c,_________________________________________________________
d._________________________________________________________
13. Who has the overall responsibility for the Patients’ Trust Fund?
__________________________________________________________
14. When is a combination changed on the lock for the safe or security
container in the Patients’ Trust Fund office?
__________________________________________________________
15. The patient can make a partial withdrawal of his funds only once a day.
a. True.
b. False.
16. Who gives notice to the local bank when the custodian transfer is
accomplished?
__________________________________________________________
17. When a check is outstanding for 12 months or longer and the payee
cannot be located, what action is taken by the custodian of the Patients’ Trust
Fund?
__________________________________________________________
__________________________________________________________
MD0752 5-27
18. Define “custodian” in the Patients’ Trust Fund.
__________________________________________________________
__________________________________________________________
19. REQUIREMENT: Using the information below, make the appropriate

entries on DA Form 3696 for MAJ Land. Include the appropriate signature.
On 29 October 199X, MAJ James E. Land was admitted (direct admission) to the
Brooke Army Medical Center where he deposited $60.00 in domestic currency in the
Patients’ Trust Fund. He also had a gold Seiko watch, an American Express Credit
Card (#7234-643321-58910), and a Texas Instruments calculator (serial number
147289). The custodian is Louise M. Oaks.
MD0752 5-28
DA Form 3696 (Patients’ Deposit Record) for exercise 19.
MD0752 5-29
20. Using the information below, make the appropriate entries on DA Form 3983 and on
DA Form 3696 for MAJ Land. Include the appropriate signatures.
PROBLEM: On 10 November 199X, MAJ Land is confined following surgery so that he is

unable to go to the custodian’s office to withdraw $10.00. The withdrawal is made and
delivered to MAJ land by the intermediate individual, Bee Lewis.
DA Form 3983, (Patient’s Trust Fund-- Authorization for Deposit or Withdrawal) for
exercise 20.
MD0752 5-30
DA Form 3696, (Patient’s Deposit Record) (for exercise 20).
Check your answers on the following pages
MD0752 5-31
1. A check is drawn payable to the “Treasurer of the United States” and

forwarded to the local finance and Accounting officer for deposit in
account “Forfeitures of unclaimed money and property.” (para 5-4d(3))
2. Patients’ Trust Fund Account. (para 5-5a(1))
3. Total amount of receipts for the day. (para 5-8b(1)(b).
4. a. Personal firearms.
b. Other weapons.
c. Pocket knives with long blades.
d. Any other items considered a menace to safety.
e. Funds and valuables for individuals not in inpatient status. (para 5-3a)
5. To safeguard, account for, and provide administrative control of patients’

funds and valuables. (para 5-1a).
6. c (para 5-8b(2))
7. When a patient is physically unable to sign the form. (para 5-6b(2))
8. Sum of columns c and d. (para 5-8b(1)(e))
9. The custodian. (para 5-8c)
10. With the name of patient and PTF account (register) number written on
the envelope. (para 5-5b(2))
11. a. Investments or loans.

b. Donations or contributions.
c. Cashing checks. (para 5-3b)
12. a. Negotiable and nongotiable instruments.

b. Valuable papers.
c. Jewelry.
d. Foreign coins and currency.
e. Expensive cameras and binoculars.
f. Billfolds. (para 5-1b(6))
13. Hospital commander. (para 5-2a)
MD0752 5-32
14. Upon the transfer of funds and valuables to a successor custodian. (para 5-4e(3))
15. b (para 5-7c(1))
16. Hospital commander. (para 5-4e(4))
17. Sends a letter to the bank requesting stop payment on the check and that
the bank annotate the copy ofthe letter the day the stop payment was effected. Then
send a check in the same amount to the local finance and accounting officer.
(para 5-8d(3))
18. The person responsible for the receipt, safekeeping, disbursement, and
accounting for patients’ funds and Valuables deposited with the fund.
(para 5-1b(1))
Solutions for exercises 19 and 20 are on the next three pages.
MD0752 5-33
DA Form 3696 (Solution for exercise 19).
MD0752 5-34
MD0752 5-35
MD0752 5-36
GLOSSARY
(Terms and Abbreviations)
ADMISSION - The act of placing an individual under treatment or observation in a

medical center or hospital. The day of admission is the day on which the medical center
or hospital makes a formal acceptance of the patient who is to be provided with room,
board, and continuous nursing service in an area of the hospital where patients normally
stay at least overnight. The admission of newborn is deemed to occur at the time of
birth.
ADMISSION, DIRECT- Admission for the first time to an MTF for current (continuous)
hospitalization. Further, the patient is one who is from a military organization or from
the area generally served by the reporting MTF. Also considered as a direct admission
is any nonmilitary person transferred from a nonmilitary medical treatment facility.
ADMISSION, DIRECT ABSENT SICK - An Army member being accounted for in an

absent sick status is a direct admission to the MTF having administrative responsibility.
Absent sick is an active duty Army patient admitted to a nonmilitary (civilian) MTF.
AI - Accidentally incurred.
AH - Army hospital.
APC- Ambulatory patient care.
AMBULATORY PATIENT CARE - Care provided to any appointed or nonappointed

patient with an acute or chronic condition who receives his care in an outpatient care
setting. Ambulatory care encompasses emergency care, primary care, and specialty
care.
ARNG- Army National Guard.
BATTLE CASUALTY- Any casualty incurred in action. “In action” characterizes the
casualty status as having been the direct result of hostile action; sustained in combat or
relating thereto; or sustained going to or from a combat mission provided that the
occurrence was directly related to hostile action. Included are persons killed or
wounded mistakenly or accidentally by friendly fire directed at a hostile force or what is
thought to be a hostile force. However, injuries due to the elements or self-inflicted
wounds and, except in unusual cases, wounds or death inflicted by a friendly force while
the individual is in an AWOL or dropped from rolls status or has voluntarily absented
himself from his place of duty are not to be considered as sustained in action and
thereby not to be interpreted as battle casualties.
MD0752 G-1
CARDED FOR RECORD ONLY (CRO) - A term which applies to those special cases
for an admission, although no admission has actually occurred. Subcourse MD0753
provides additional information .
DENTAC - US Army Dental Activity. A dental treatment organization which provides

professional care and services; supervises the preventive dentistry program, conducts
education programs, and supervises clinical investigations and research and
development activities when needed.
Dg (DIAGNOSIS) - Every disease and injury requiring treatment or observation at a

medical treatment facility; every complication and additional disease or injury diagnosed
and treated during a current and continuous episode of treatment; and every change in
diagnosis as recorded in medical and clinical records.
DIED OF WOUNDS RECEIVED IN ACTION (DOW) - The term used to describe all
battle casualties who die of wounds or other injuries in action after having reached any
medical treatment facility. It is essential to differentiate these cases from battle
casualties found dead or who died before reaching a medical treatment facility (the
“killed in action” group). It should be noted that reaching a medical treatment facility
while still alive is the criterion.
DISPOSITION - Same as final disposition except includes transfer to another US

military medical center or hospital.
EXISTED PRIOR TO SERVICE (EPTS) - A term added to a medical diagnosis to signify

that there is clear and unmistakable evidence that the disease or injury, or the
underlying condition producing the disease or injury, existed prior to the individual’s
entry into military service.
FINAL DISPOSITION - An inpatient no longer carried on rolls of the US military

medical center or hospital by reason of discharge to duty; discharge to home, death,
separation/retirement; or other termination of inpatient status. The day of discharge is
the day which the medical center or hospital formally terminates the period of inpatient
hospitalization.
FMC - DD Form 1380 (US Field Medical Card). Used by aid stations, clearing stations ,
or nonfixed medical treatment facilities (except hospitals) operating overseas, on
maneuvers, or attached to commands moving between stations for persons treated as
inpatients or carded for record only may also be used to record outpatient treatment for
Health Record file.
FMP (FAMILY MEMBER PREFIX) - The 2-digit prefix used with the social security
number to identify a patient’s category.
MD0752 G-2
HOSPITAL - A health treatment facility capable of providing definitive inpatient care. It
is staffed and equipped to provide diagnostic and therapeutic services in the fields of
general medicine and surgery, preventive medicine services, and has the supporting
facilities to perform its assigned mission and functions. A hospital, may, in addition,
discharge the functions of a clinic.
HREC (HEALTH RECORD) - A Health Record is a permanent, continuous, locally

available file that contains basic documents prepared when an individual enters military
service and in which additional documents are prepared when the member receives
medical and dental care on an excused-from-duty or outpatient basis.
INPATIENT - An inpatient is an individual, other than a transient patient, who is

admitted (placed under treatment or observation) to a bed status in a US military MTF
which has authorized or designated beds for inpatient medical or dental care.
INPATIENT TREATMENT RECORD (ITR) - The medical record used at a MTF that has
authorized beds for inpatient medical or dental care. It is begun on admission to the
MTF and completed at the end of hospitalization. This record applies to all
beneficiaries.
INDIVIDUAL PATIENT DATA SYSTEM (IPDS) - IPDS is a computer oriented

collection of selected demographic and medical data for inpatients treated by the Army
Medical Department (AMEDD) and for certain other cases of sufficient interest to
require reporting as “carded for record only” (CRO) (see para 3-12, AR 40-66). The
system also includes data on active duty Army personnel while in an “absent sick”
status in civilian hospitals.
KILLED IN ACTION (KIA) - Refers to personnel who are killed or who die in wounds or
other injuries received in action before reaching any military MTF.
MEDCEN - Medical center.
MEDICAL CENTER - A medical center is a large hospital staffed and equipped to

provide health care for authorized persons including a wide range of specialized and
consultive support for all medical facilities in the assigned geographic area.
MEDDAC - Medical department activity. The MEDDAC is an organizational structure

which combines the health care assets from a geographic area under a single
commander. It is a TDA organization under the jurisdiction of the Commander,
Headquarters, US Army Medical Command.
MILPO - Military Personnel Office.
MPRJ - Military Personnel Records Jacket.
MTF - Medical treatment facility.
MD0752 G-3
NONBATTLE CASUALTY - Any person lost to his/her organization ( killed, missing, ill,
injured, or incapacitated), provided such loss is not the result of hostile action.
Included are casualties inside or outside a theater of operations.
OUTPATIENT - An outpatient is an individual receiving health service for an actual or

potential disease or injury that does not require admission to a medical facility for
inpatient care.
OUTPATIENT CARE - Medical and medical-related services and supplies which are
provided at a medical treatment facility for a patient who is not carried as an inpatient.
OUTPATIENT TREATMENT RECORD (OTR) - A medical record prepared for each

civilian patient treated as an outpatient at a U. S. Army medical and dental treatment
facility. It provides a concise and complete record of diagnosis and treatment for each
civilian treated as an outpatient at an MTF.
PAD - Patient Administration Division. This division provides the patient administration
services for the hospital. The chief supervises personnel in the maintenance of all
medical records of inpatients and outpatients.
PHYSICAL PROFILE - Estimate of overall ability of an individual to perform military

duties by consideration of physical and mental condition. Six factors designated
PULHES are expressed numerically. These factors are: P-physical capacity or stamina ;
U--upper extremities; L--lower extremities; H--hearing (including ear defects); E--eyes;
and S--neuropsychiatric.
PRC - Patient recording card. This card contains basic identification information and is
used to enter mechanically imprinted information data on forms filed in the OTR and
HREC.
PRIMARY CARE - Sick call level care provided to a member. A troop clinic or
ambulatory health clinic is considered primary care. Clinics are medical treatment
activities that are staffed and equipped to provide emergency treatment and ambulatory
services as well as perform nontherapeutic activities related to the health of the
personnel serviced.
SPECIAL CATEGORY RECORD - This is a medical record which is individually

identified and specially handled to reduce the risk of harming or embarrassing the
patient and to ensure its medicolegal integrity.
SSN - Social security number.
TERMINAL DIGIT FILING SYSTEM (TDFS) - A system of filing medical records using
color coded and numerically printed folders to enhance the speed and accuracy of filing
medical records.
MD0752 G-4
TRF ADM (TRANSFER ADMISSION) - Admission to a medical treatment facility after
being recorded as a direct admission by some other military medical treatment facility
for the current uninterrupted episode of disease or injury.
WIA - (WOUNDED IN ACTION) - A casualty other than “killed in action” who has
incurred a traumatism or injury due to external agent or cause as the result of hostile
action.
MD0752 G-5
COMMENT SHEET
SUBCOURSE MD0752 Patient Accountability Branch EDITION 101

Your comments about this subcourse are valuable and aid the writers in refining the subcourse and making it
more usable. Please enter your comments in the space provided. ENCLOSE THIS FORM (OR A COPY) WITH
YOUR ANSWER SHEET ONLY IF YOU HAVE COMMENTS ABOUT THIS SUBCOURSE..
FOR A WRITTEN REPLY, WRITE A SEPARATE LETTER AND INCLUDE SOCIAL SECURITY NUMBER, RETURN
ADDRESS (and e-mail address, if possible), SUBCOURSE NUMBER AND EDITION, AND
PARAGRAPH/EXERCISE/EXAMINATION ITEM NUMBER.
PLEASE COMPLETE THE FOLLOWING ITEMS:

(Use the reverse side of this sheet, if necessary.)
1. List any terms that were not defined properly.
2. List any errors.
paragraph error correction
3. List any suggestions you have to improve this subcourse.
PRIVACY ACT STATEMENT (AUTHORITY: 10USC3012(B)

4. Student Information (optional)
AND (G))
Name/Rank PURPOSE: To provide Army Correspondence Course Program
SSN students a means to submit inquiries and comments.
Address
USES: To locate and make necessary change to student records.
E-mail Address DISCLOSURE: VOLUNTARY. Failure to submit SSN will prevent

Telephone number (DSN) subcourse authors at service school from accessing
student records and responding to inquiries requiring
MOS/AOC
such follow-ups.
U.S. ARMY MEDICAL DEPARTMENT CENTER AND SCHOOL Fort Sam Houston, Texas 78234-6130

US Army Medical Course MD0752-101 - Patient Accountability Branch

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ARMY MEDICAL DEPARTMENT CENTER AND SCHOOL

Application for enrollment should be made at the Internet website: http://www.atrrs.army.mil.

For comments or questions regarding enrollment, student records, or shipments, contact

NONRESIDENT INSTRUCTION BRANCH

Lesson Paragraphs Page

1 ADMISSION AND DISPOSITION PROCESSING ..................... 1-1--1-19 1-1

Section I. Reception, Identification, and Definition ............. 1-1--1-3 1-2

Exercises ................................................................................... 1-52

2 ABSENT SICK PROCESSING.................................................... 2-1--2-8 2-1

Section I. Administration of Army Military Patients in

Exercises ................................................................................... 2-8

3 MEDICAL REGULATING AND AEROMEDICAL EVACUATION 3-1--3-30 3-1

Section I. Introduction............................................................... 3-1--3-9 3-2

Exercises ................................................................................... 3-52

4 MEDICAL SERVICES ACCOUNT.............................................. 4-1--4-15 4-1

Section I. Introduction............................................................... 4-1--4-2 4-2

Exercises .................................................................................... 4-25

Section I. Introduction and Principles .............................................5-1--5-5 5-2

1-1 DD Form 689 (Individual Sick Slip)..................................................................... 1-9

3-9 DD Form 602 (Patient Evacuation Tag)............................................................. 3-40

1-1A TO&E hospital codes............................................................................................ 1-12

PATIENT ACCOUNTABILITY BRANCH

Lesson Materials Furnished:

Procedures for Subcourse Completion:

--Read and study each lesson carefully.

Student Comment Sheet:

LESSON 1 Admission and Disposition Processing.

TEXT ASSIGNMENT Paragraphs 1-1 through 1-19.

TASKS TAUGHT 081-866-0003, Verify the Eligibility of Patient.

1-1. Identify the five types of admission.

1-2. Define the term “disposition.”

1-3. Assign and record register numbers in the register

1-4. Given a situation, prepare DA Form 2985 (Admission

1-5. Given a DA Form 2985 of a patient that has been

1-6. Identify the categories of patients which require

1-7. Given a patient transaction, identify the major and

SUGGESTION After studying the assignment, complete the exercises of

ADMISSION AND DISPOSITION PROCESSING

Section I. RECEPTION, IDENTIFICATION, AND DEFINITION

1-1. RECEPTION OF THE PATIENT

a. Attitude. The reception given by professional and administrative personnel when

b. Information. Avoid summarizing hospital regulations, such as the policy for

c. Essential Admission Processing. Patients requiring immediate emergency

(1) Review DA Form 2985 (Admission and Coding Information) or

(2) Verify eligibility for care.

(3) Collect other information required for preparing medical records

(4) Initiate the Inpatient Treatment Record (ITR).

(5) Obtain insurance information.

a. Identification Forms. The identification of a person seeking care or treatment at

(1) DD Form 2A (green) (Identification Card). Military personnel on active duty,

(2) DD Form 2A (green) (Res). Members of the Reserve components not on

(3) DD Form 2A (blue) (Ret). Retired members entitled to retirement pay.

(4) Forms issued by appropriate authority for commissioned officers of the

(5) DD Form 1173 (Uniformed Services Identification and Privilege Card).

NOTE: DEERS (Defense Enrollment Eligibility Reporting System) is a

b. Authorization. Other personnel are eligible to receive medical care

(2) Veterans Administration authorization form prior to hospitalization of

(3) CA Form 16 (Request for Examination and/or Treatment) for beneficiaries of

(4) Public Health Services authorization signed by appropriate authority for

(6) DD Form 214 (Armed Forces of United States Report of Transfer or

(7) Other forms of authorization, such as travel orders and identification

1-3. EXPLANATION OF TERMS FOR ADMISSION AND DISPOSITION (AAD)