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

c. Civilians interned by the Army. Such individuals will be provided hospitalization in Armed Forces MTFs only in
the absence of adequate civilian facilities. (See para 3-38.)
d. Other categories of beneficiaries. Other categories of beneficiaries may be treated in other Federal facilities.
However, the patient administrator will coordinate with the receiving facility prior to referral to ensure care is
authorized according to that Federal facility’s rules of care and that reimbursement methodologies are acceptable to the
Army MTF commander.
9–5. Authorization
DA Form 4159 (Request for Medical Care in a Federal Medical Treatment Facility Outside Department of Defense) is
used to authorize care in Federal MTFs for Army beneficiaries. A commander may authorize care for a Soldier under
his or her command when required in a Federal MTF. DA Form 4159 is prepared in triplicate and is addressed to the
officer in charge of the Federal MTF in which care is desired. The patient presents the original and one copy of the
form to the MTF when applying for treatment. In an emergency, care may be furnished without such a request;
however, DA Form 4159 should be forwarded after the event. DA Form 4159 is not required for active and retired
Army members. Identification will be made by DD Form 2 (ACT) (Armed Forces of the United States—Geneva
Conventions Identification Card (Active)) or DD Form 2 (RET) (United States Uniformed Service Identification Care
(Retired)). DA Form 4159 is available on the APD Web site (www.apd.army.mil).
9–6. Use of Federal medical treatment facilities for supplementation
When it is necessary to use the services of other Federal MTFs to supplement Army MTFs or MEPS, commanders may
obtain such services upon their written request direct to the officer in charge of the Federal MTF concerned. Vouchers
for these services will be sent to the facility requesting the services and paid from local operating funds.
9–7. Reimbursement to other Federal facilities
Vouchers for care furnished by Federal MTFs will be prepared by the agencies concerned. They will be sent (supported
by copies of DA Form 4159, when appropriate) to Commander, USAMEDCOM, ATTN: MCRM-F, 2050 Worth Road,
Fort Sam Houston, TX 78234-6000 for settlement with the following exceptions.
a. Vouchers for services incurred by applicants identified in paragraphs 3-4 through 3-8 will be settled by the MEPS
requesting services. Emergency medical care for acute illnesses and injuries identified in paragraph 3-8 are forwarded
to Commander, USAMEDCOM, ATTN: MCRM-F, 2050 Worth Road, Fort Sam Houston, TX 78234-6000.
b. Vouchers for quadrennial medical examinations of USAR personnel will be forwarded to the appropriate MCS
contractor.
c. Vouchers for medical examinations performed for members and prospective members of the RC will be paid by
the State concerned.
d. Vouchers for services obtained for DA Federal civilian employees addressed in paragraph 3-14 will be settled
locally by the organization arranging for the occupational health services.
9–8. Special consideration of Uniformed Services Family Health Plan beneficiaries
Uniformed Services beneficiaries enrolled in the Uniformed Services Family Health Plan (USFHP) (see fig 9-1)
managed care plan are not eligible beneficiaries at Army MTFs except for emergencies or until disenrolled. AD Army
personnel are not eligible for the USFHP.
9–9. Administration of patients treated at Federal MTFs other than the Uniformed Services and
civilian facilities
Army MTF commanders are responsible for coordinating the care of AD Army patients treated at Federal MTFs other
than the Uniformed Services and at civilian facilities. Major Army medical commanders are assigned GARs. The
listing of GARs can be found at the Army Medicine Web site (www.armymedicine.army.mil). When AD Army general
officers are admitted to or released from Navy, Air Force, or other Federal or civilian MTFs, the MTF assigned
administrative responsibility will follow procedures specified in paragraph 6-3. When an AD Army member is admitted
to a non-Army MTF or placed in quarters by a nonmilitary physician, the appropriate Army MTF commander will—
a. Provide necessary professional medical evaluation and assistance. If the patient is receiving care from a civilian
agency, a physician at the responsible Army MTF will promptly contact the attending civilian physician to determine
the patient’s condition and the feasibility of evacuation to an MTF.
b. Notify the patient’s parent unit except when notification has already been accomplished.
c. Provide strength accounting, pay and allowances, and other personnel functions for patients assigned to an WTU
and needed personnel functions except pay and allowances for patients attached to an WTU. (See chap 8.) These
functions will be accomplished even though the patient is not physically located within the Army MTF having
administrative responsibility. Army members hospitalized in Navy or Air Force MTFs are accounted for and substantiated
by Navy or Air Force AAD reports or other similar documents.
AR 40–400 27 January 2010
67