Patient Administration - Army Publishing Directorate - U.S. Army

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ABCA QSTAG 470 Documentation Relative to Medical Evacuation, Treatment, and Cause of Death of Patients. (This publication may be obtained from the DOD Single Stock Point, Code 3015, 5801 Tabor Avenue, Philadelphia, PA 19120-5099.) DOD 6010.15–M Military Treatment Facility Uniform Business Office (UBO) DODD 6010.22 National Disaster Medical System (NDMS) DODI 5154.30 Armed Forces Institute of Pathology Operations DODI 6015.23 Delivery Of Healthcare at Military Treatment Facilities: Foreign Service Care; Third-Party Collection; Beneficiary Counseling and Assistance Coordinators (BCACs) Federal Benefits for Veterans and Dependents This pamphlet can be obtained from the VA Office of Public Affairs (80D), 810 Vermont Ave., NW, Washington, DC, 20008 or from any VA medical facility. ICD–9–CM International Classification of Diseases (ICD)-Ninth Revision-Clinical Modification. (Copies of this 3-volume set may be obtained from the Superintendent of Documents, Government Printing Office, Washington, DC 20402-9325.) Joint Commission on Accreditation of Healthcare Organizations Accreditation Manual for Hospitals This manual may be obtained from the Joint Commission on Accreditation of Healthcare Organizations, One Renaissance Boulevard, Oakbrook Terrace, IL 60181. Manual for Courts–Martial 2005 Edition (Available on the APD Web site: http://www.apd.army.mil.) NATO STANAG 2061 Procedures for Disposition of Allied Patients by Medical Installations. (NATO STANAGs may be obtained from the DOD Single Stock Point, Code 3015, 5801 Tabor Avenue, Philadelphia, PA 19120-5099.) NATO STANAG 2101 Principles and Procedures for Establishing Liaison NATO STANAG 2132 Documentation Relative to Medical Evacuation, Treatment, and Cause of Death of Patients NATO STANAG 3113 Provision of Support to Visiting Personnel, Aircraft, and Vehicles NGR 40–400 Patient Administration for Members of the Army National Guard NGR 40–501 Medical Examination for Members of the Army National Guard RCS MED–363 Abortion Statistics Report ST 4–02.46 Medical Support for Detainee Operations TM 8–300/NAVMED P–5065/AFM 160–19 Autopsy Manual 96 AR 40–400 27 January 2010
VASRD Veteran’s Administration Schedule for Rating Disabilities. (This publication is available on the VA Web site or by writing to the Department of Veteran’s Affairs (Directives, Forms, and Records Staff), 810 Vermont Avenue NW, Washington, DC 20420.) (Available at http://www.warms.vba.va.gov/bookc.html.) Section III Prescribed Forms Unless otherwise indicated, Department of the Army (DA) forms can be downloaded from the Army Publishing Directorate (APD) Web site at: http://www.apd.mil. DD Forms are available at the DOD forms Web site at: http:// www.dtic.mil.whs/directives/infomgt/forms/index.htm/. DA Form 2631 Medical Care-Third Party Liability Notification (Prescribed in paras 13-1f, 13-3b(2), 13-6.) DA Form 2984 Very Seriously Ill/Seriously Ill/Special Category Patient Report (Prescribed in para 6-2b(1).) DA Form 2985 Admission and Coding Information (Prescribed in paras 4–6a, 4–6c, 13–3b.) DA Form 3153 (obsolete) Medical Service Account Patient Ledger Card (Prescribed in para 11–9.) DA Form 3154 MSA Invoice and Receipt (Prescribed in paras 11–7a, 11–9, 13–6d(1), C–3c(9), C–3c(17).) DA Form 3155 MSA Cash Record (Prescribed in para 11–9.) DA Form 3647 Inpatient Treatment Record Cover Sheet (Prescribed in paras 13–3b(3), 13–5b.) DA Form 3647–1 Inpatient Treatment Record Cover Sheet (for Plate Imprinting) (Prescribed in para 13-3b(3).) DA Form 3648 Coding Transcript-Individual Patient Data System (Prescribed in para 4–6a.) DA Form 3696 Patient’s Deposit Record (Prescribed in paras 12–4a, 12–7, 12–8.) DA Form 3821 Report of Administrative Officer of the Day (Prescribed in para 6–2a.) DA Form 3894 Hospital Report of Death (Prescribed in para 6–4a.) DA Form 3904 Public Voucher for Medical Examination (Prescribed in para 3–25a(2).) DA Form 3910 Death Tag (Prescribed in para 6-4b.) DA Form 3929 MSA-Accounts Receivable Register and Control Ledger (Prescribed in para 11–9.) DA Form 3947 Medical Evaluation Board Proceedings (Prescribed in paras 7–8a, 7–8b, 7–9, 7–10.) AR 40–400 27 January 2010/RAR 15 September 2011 97
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Army Regulation 40-400 Medical Serv
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Headquarters Department of the Army
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Contents—Continued Department of
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Contents—Continued Autopsy author
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Contents—Continued Chapter 13 Inj
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Chapter 1 Introduction 1-1. Purpose
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nonemergent specialty care. The Pri
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(1) If not prohibited under the law
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Table 2-3 Supplemental care payment
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a. Treatment during and after duty.
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the camp commander or the MTF comma
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e provided an employee paid from ap
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(2) The Health Insurance Portabilit
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(n) Section 13. Signature of the MT
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discharged or transferred. When an
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encompasses the geographic area whe
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(3) Peace Corps applicants. (a) Exc
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the emergency. The patient or respo
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physicians, dentists, nurses (pract
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. Each Uniformed Service secretary
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3-61. Treatment of former military
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Figure 3-2. Sample format memorandu
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4-3. Comfort items for patients a.
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Kingdom, and the United States The
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f. The MTF commander who starts act
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(1) Attempt to arrange transfer to
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(3) Patients who are being or have
Page 55 and 56: personal decisions will be assisted
Page 57 and 58: authorities, to the sponsor or NOK.
Page 59 and 60: (2) Enabling care (EC). AD patients
Page 61 and 62: patients in absent sick status, cha
Page 63 and 64: date the packet is mailed to the PE
Page 65 and 66: (4) A complete, current report of m
Page 67 and 68: Table 7-1 Distribution of medical b
Page 69 and 70: d. Instructions for the preparation
Page 71 and 72: . After approval by the Service rev
Page 73 and 74: . Soldiers who are in initial entry
Page 75 and 76: a. The following information will b
Page 77 and 78: c. Civilians interned by the Army.
Page 79 and 80: a. Members of the Army, RC, and app
Page 81 and 82: medical documents by submitting DD
Page 83 and 84: 11-10. Audit and review The MSA is
Page 85 and 86: lost. The MSA must have the interna
Page 87 and 88: Figure 11-2. Sample memorandum form
Page 89 and 90: Chapter 12 Patients’ Trust Fund 1
Page 91 and 92: (2) Deposits and requests for check
Page 93 and 94: whom administrative responsibility
Page 95 and 96: 13-7. Concurrent medical affirmativ
Page 97 and 98: (4) Establish a process whereby all
Page 99 and 100: (1) Receive and open mail including
Page 101 and 102: d. Patient administrators of deploy
Page 103 and 104: AR 215-1 (not cited) Military Moral
Page 105: AR 36-2 Audit Services in the Depar
Page 109 and 110: DA Form 5009 Medical Record-Release
Page 111 and 112: Appendix B Persons authorized care
Page 113 and 114: Table B-1 Persons authorized care a
Page 127 and 128: (3) Is there a procedure in place t
Page 129 and 130: Glossary Section I Abbreviations AA
Page 131 and 132: EIN employee identification number
Page 133 and 134: MPRJ military personnel records jac
Page 135 and 136: REP 63 Reserve Enlistment Program o
Page 137 and 138: VA Veterans Affairs VARO Veterans A
Page 139 and 140: Disability separation Temporary or
Page 141 and 142: Maximum hospital benefit That point
Page 143 and 144: standard CHAMPUS cost shares apply.
Page 145 and 146: Convalescent leave, 5-1 Cosmetic su
Page 147 and 148: Civilian participants in Army-spons
Page 149 and 150: For assignment to WTU, 8-3 Outside
Page 151 and 152: Special consideration of USFHP bene
Page 153 and 154: Social Security, table 2-1, 3-21, 3
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Patient Administration - Army Publishing Directorate - U.S. Army

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