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

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Figure 11–3. Sample memorandum format for statement of outgoing custodian Figure 11–4. Sample memorandum format for statement of new custodian 78 AR 40–400 27 January 2010
Chapter 12 Patients’ Trust Fund 12–1. Purpose This chapter prescribes the accountability and control of patients’ personal funds and valuables in Army MTFs. The Medical Services Account Users’ Manual prescribes procedures for PTF transactions. 12–2. Administration No council is necessary for the administration of a PTF. 12–3. Responsibilities a. The MTF commander will be responsible for the overall operation of the PTF and for the proper safeguarding of patients’ funds and valuables. Specifically he or she will— (1) Designate-in writing-an officer, warrant officer, or civilian employee as custodian of the PTF during both duty and after-duty hours. (2) Designate in writing such additional individuals as are required for the efficient operation of the PTF during both duty and after duty hours. (3) Determine the amount of cash to be kept on hand in the change fund and notify the custodian in writing of the amount authorized. (4) Ensure the implementation and maintenance of a viable internal control program. b. The custodian of the PTF will be responsible for the receipt, safekeeping, disbursements, and accounting for patients’ funds and valuables deposited with the fund. If the custodian is absent in excess of 30 days, the MTF commander will appoint a replacement to assume the duties of the custodian. 12–4. Transfer of funds and valuables to successor custodians When a custodian is relieved and a successor custodian designated, transfer or accountability of the PTF will be accomplished as described in a through e below. a. The retiring custodian will close and balance the DA Form 4128 (Patients’ Trust Fund Journal) as of the date of transfer to include a cash (on hand) count and a trial balance of the funds on deposit per DA Form 3696 (Patient’s Deposit Record). In addition, a reconciliation will be prepared to show both the bank and journal balances. DA Form 4128 may be obtained through normal distribution channels. DA Form 3696 is available on the APD Web site (www. apd.army.mil/). The following instructions are furnished for use in maintaining DA Form 4128: (1) Column (a). Enter the date of entry. (2) Column (b). Enter the total amount of receipts for the day. (3) Column (c). Enter the total amount of cash disbursements for the day. (4) Column (d). Enter the total amount of check disbursements for the day. (5) Column (e). Enter the sum of columns (c) and (d). (6) Column (f). To the previous day’s balance, add the receipts shown in column (b), deduct therefrom the withdrawals shown in column (e), and enter the total. At the beginning of each month, the initial entry will be the fund balance brought forward from the last day of the preceding month. (7) 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 total except when it exceeds the authorized amount of the change fund. In this case, enter the authorized amount of the change fund, and record the difference between total cash on hand and the authorized amount of change fund “for deposit” in column (h). At the beginning of each month, the initial entry will be the change fund balance brought forward from the last day of the preceding month. (8) Column (h). Enter the amount for deposit as computed in column (g). The amount may be accumulated until a deposit is made. (9) Column (i). Enter the number of the check drawn to bring the change fund up to the authorized amount. (10) Column (j). When the change fund falls below the authorized amount, a check will be drawn to bring the change fund up to the authorized amount. The amount of the check will be entered in this column. (11) Column (k). Enter the sum of columns (g) and (h) or (j), as applicable. (12) Column (l). Enter the bank balance per checkbook. At the beginning of each month, the initial entry will be the bank balance brought forward from the last day of the preceding month. (13) 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 will be the total fund balance brought forward from the last day of the preceding month. AR 40–400 27 January 2010 79
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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
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 and 48: Kingdom, and the United States The
Page 49 and 50: f. The MTF commander who starts act
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: Figure 11-2. Sample memorandum form
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 and 106: 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
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
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Disability separation Temporary or
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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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