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

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Disability Program are exercised through the U.S. Army Physical Disability Agency. Procedures are addressed in AR 635-40. 5–3. Types of disposition for Army members a. Full duty. Patients who are medically fit to perform duty without restrictions or assignment limitation will be returned to full duty. This disposition may be made by the attending medical officer or upon the approved recommendation of an MEB. b. Temporarily restricted duty (temporary profile). This disposition will apply to patients who are recovering from sickness or injury and are likely to become fit to perform duty. Such patients will be evaluated at least once every 3 months with the goal of upgrading their duty status. No person may remain in this status for more than 12 months. Such disposition involving 3 months or less should be made by the attending medical officer (AR 40-501). c. Trial duty (temporary profile). Patients whose fitness for duty is questionable may be recommended for trial duty. A person on such duty will be evaluated at least once every 3 months with the goal of upgrading duty status or separate from the Service, if appropriate. Persons will not be retained on trial duty for more than 12 months. d. Duty with permanent assignment limitations (permanent profile). Patients who meet retention standards and who can perform duty with specific permanent assignment limitations will be permanently profiled. Those who do not meet retention standards and who are recommended for continuance on AD as outlined in AR 635-40 will have their permanent assignment limitations identified by the MEB processing the case. e. Duty for separation or separation recommended. (1) Patients who do not have a condition listed in AR 40-501 and who are scheduled for any administrative separation or retirement, will be returned to duty for separation. This disposition may be made by either the attending medical officer or the MTF commander. (2) Patients who have a condition listed in AR 40-501 and do not require active hospitalization, will be processed according to AR 635-40. This applies when the person is eligible for and elects separation for an EPTS condition which has not been aggravated by service. This disposition can be made by the MEB on an outpatient basis. (3) An enlisted patient who does not have a condition listed in AR 40-501 and did not meet the procurement medical fitness standards (AR 40-501) at the time of induction or initial enlistment will be processed for separation according to AR 635-200. To be processed under AR 635-200, the condition must have been identified within the first 6 months and an EPTS board initiated. (4) Patients who do not have a condition listed in AR 40-501 but are considered unsuitable for further military service by either MEB authority or unit commander, will be returned to duty with separation recommended under the appropriate administrative regulation. f. Transfer to a VA treatment facility or other MTF. (See para 5-18a.) g. Referral to a PEB. (See para 7-21.) h. Absent without leave (AWOL). When patients are AWOL for 10 consecutive days, their clinical records will be closed. This disposition is made by the attending medical officer. i. Death. 5–4. Recommendation for change of duty or station An MEB will process U.S. military patients with physical defects or medical conditions that warrant a change of duty or station. The medical responsibility is either to evacuate the patients or to advise their unit commander of the medical reasons for the change. Under no circumstances will the patient be given a written statement and instructed to apply for a transfer or change of assignment because of medical reasons. 5–5. Return of Army military patients from overseas to CONUS for medical reasons Overseas MTF commanders may return Army military patients from overseas to CONUS for medical reasons when, after coordination with the member’s commander, they determine that such action is in the best interests of the Army and the patient. a. MTF commanders will determine whether a patient being returned to CONUS under this paragraph will appear before an MEB before evacuation. b. If hospitalization or active medical supervision is required while in a travel status, the patient will be evacuated through medical channels. c. If hospitalization or active medical supervision is not required while in a travel status, the patient will be returned to CONUS through regular administrative channels by the fastest means. Normally, Government transportation will be used. d. When it is determined that a patient is to be returned to CONUS in an inpatient status, a request for MTF designation will be sent through normal medical regulating channels to the Global Patient Movement Requirements Center (GPMRC), Scott AFB, IL 66225-5300. e. Inpatients will be transferred as soon as possible after receipt of an MTF designation from GPMRC. The patient will be assigned or attached to the WTU of the designated MTF as provided in paragraphs 8-5 and 8-6. 38 AR 40–400 27 January 2010
f. The MTF commander who starts action to return a patient to CONUS administratively will determine whether leave or delay en route is medically sound. If not, such patients will not be granted leave or delay en route. g. MTF commanders will assure that the ITR, when applicable, and the health record (HREC) are assembled before the patient’s departure. They will also advise the personnel records custodian regarding the designated CONUS MTF where the patient will be assigned or attached. Records will be assembled and sent as specified below. (1) If the patient is being returned through medical channels and attached to the receiving CONUS MTF, only a copy of the ITR will accompany him or her. (2) If the patient is being returned through administrative channels and attached to the CONUS MTF, the patient will hand carry his or her HREC and ITR when no leave or delay en route is authorized. When leave or delay en route is authorized, the patient will hand carry the HREC; however, the ITR will be airmailed to the receiving MTF immediately upon completion of the record. The patient’s military personnel records jacket (MPRJ) will be retained in the overseas command. (3) If the patient is being returned through administrative channels and assigned to the CONUS MTF, he or she will hand carry the MPRJ with HREC and ITR when no leave or delay en route is authorized. When leave or delay en route is authorized, the patient will hand carry the MPRJ with HREC; however, the ITR will be airmailed to the receiving MTF to arrive before or upon arrival of the patient. (4) When hand carrying personnel records is not advisable (AR 600-8-104), these records will be sent by mail to the receiving MTF to arrive before or upon the arrival of the patient. h. The following members in an overseas command will be processed for disposition in the overseas command: (1) Hospitalized members who are authorized separation in an overseas command (AR 600-8-24 and AR 635-200). TDRL members who are residing in an overseas area while being evaluated will be processed in that command if the MTF has the capability. (2) Members being considered for referral to a PEB who do not require evacuation to CONUS for medical treatment. MEB proceedings will be prepared according to this regulation and AR 635-40 and forwarded to the appropriate PEB. If such members demand a formal hearing, they will be ordered to a PEB in CONUS on TDY status. (AR 635-40 contains detailed procedures.) i. PCS evacuation orders on officer patients should receive distribution as shown in AR 600-8-105. 5–6. Length of hospitalization for AD Army Soldiers a. Army personnel on AD for more than 30 days who are likely to be medically fit for return to duty within 12 months are given maximum hospital benefits. b. Patients not likely to be medically fit for return to duty within 12 months will be processed for disposition after receiving optimum hospital benefit. An MEB/PEB is appropriate because these patients may continue treatment in a TDRL/permanent disability retired list status. c. Active Army personnel who will require hospitalization or disability processing beyond their term of service may be extended on AD upon approval by AHRC for officers or by general courts-martial authority for enlisted personnel. AR 600-8-24 defines procedures for extension of officers and AR 635-200 for extension of enlisted personnel. Officer extensions will be processed through OTSG (DASG-PTZ), 5109 Leesburg Pike, Falls Church, VA 22041-3258. MEB/ PEB processing for Soldiers extended on AD will be closely monitored and expedited to the extent possible. d. For RC Soldiers who require hospitalization or disability processing beyond their duty period, refer to AR 135- 381. 5–7. Use of subsisting out status Military patients may be permitted to live outside the MTF in a subsisting out status while receiving required medical care. (This status is used to distinguish these days from occupied bed days.) Subsisting out status applies to inpatients whose constant presence in the hospital is not essential to treatment. Arrangements for subsistence and lodging must be acceptable to the MTF commander. Patients discharged but retained as attached to the WTU may be placed in a subsisting out status. Lodging used by subsisting out patients will be located within the vicinity of the MTF. The MTF commander will determine maximum distance for subsisting elsewhere. This status will not be used when another means, such as leave, is more appropriate or when the patient’s needs can be met as an outpatient. Subsisting out status will not delay the final disposition of a patient from the MTF. Military patients in subsisting out status continue to be carried on the rolls (assigned or attached/inpatient or outpatient) of the MTF WTU. Patients subsisting out may be expected to report daily to the WTU and perform limited duty within the limits of profile restrictions. When patients subsist elsewhere, they do not accrue hospital charges. 5–8. Members on the temporary disability retired list A person placed on the TDRL is legally required to undergo a medical examination at least once every 18 months. The purpose of the TDRL periodic medical examination is to— a. Determine the member’s condition. b. Decide if a change has occurred in the disability for which the member was placed on the TDRL. AR 40–400 27 January 2010 39
Page 1 and 2: Army Regulation 40-400 Medical Serv
Page 3 and 4: Headquarters Department of the Army
Page 5 and 6: Contents—Continued Department of
Page 7 and 8: Contents—Continued Autopsy author
Page 9 and 10: Contents—Continued Chapter 13 Inj
Page 11 and 12: Chapter 1 Introduction 1-1. Purpose
Page 13 and 14: nonemergent specialty care. The Pri
Page 15 and 16: (1) If not prohibited under the law
Page 17 and 18: Table 2-3 Supplemental care payment
Page 19 and 20: a. Treatment during and after duty.
Page 21 and 22: the camp commander or the MTF comma
Page 23 and 24: e provided an employee paid from ap
Page 25 and 26: (2) The Health Insurance Portabilit
Page 27 and 28: (n) Section 13. Signature of the MT
Page 29 and 30: discharged or transferred. When an
Page 31 and 32: encompasses the geographic area whe
Page 33 and 34: (3) Peace Corps applicants. (a) Exc
Page 35 and 36: the emergency. The patient or respo
Page 37 and 38: physicians, dentists, nurses (pract
Page 39 and 40: . Each Uniformed Service secretary
Page 41 and 42: 3-61. Treatment of former military
Page 43 and 44: Figure 3-2. Sample format memorandu
Page 45 and 46: 4-3. Comfort items for patients a.
Page 47: Kingdom, and the United States The
Page 51 and 52: (1) Attempt to arrange transfer to
Page 53 and 54: (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
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(1) Receive and open mail including
Page 101 and 102:
d. Patient administrators of deploy
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AR 215-1 (not cited) Military Moral
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AR 36-2 Audit Services in the Depar
Page 107 and 108:
VASRD Veteran’s Administration Sc
Page 109 and 110:
DA Form 5009 Medical Record-Release
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Appendix B Persons authorized care
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Table B-1 Persons authorized care a
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Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
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(3) Is there a procedure in place t
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Glossary Section I Abbreviations AA
Page 131 and 132:
EIN employee identification number
Page 133 and 134:
MPRJ military personnel records jac
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REP 63 Reserve Enlistment Program o
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VA Veterans Affairs VARO Veterans A
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Disability separation Temporary or
Page 141 and 142:
Maximum hospital benefit That point
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standard CHAMPUS cost shares apply.
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Convalescent leave, 5-1 Cosmetic su
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Civilian participants in Army-spons
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For assignment to WTU, 8-3 Outside
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Special consideration of USFHP bene
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Social Security, table 2-1, 3-21, 3
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Patient Administration - Army Publishing Directorate - U.S. Army

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