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

(2) Deposits and requests for checks will be made through the MSA. A separate deposit slip and collection voucher
will be used for each patient.
(3) The chief of PAD will ensure the security of the PTF by periodically reviewing internal controls and SOPs. On a
random monthly basis, the chief of PAD will assign a disinterested third party to audit the PTF.
b. Valuables. Valuables will be placed in a safe or other container or room which provides the same degree of
protection.
c. Loss of funds or valuables. When a shortage in the funds or a loss of property is discovered, the matter will be
investigated and disposed of according to AR 15-6. When losses of funds are not recoverable and it has been
determined that there was no fraud, dishonesty, or willful misconduct and no one is held pecuniarily liable, the fund
should be liquidated and a claim initiated against the Government according to AR 27-20.
12–7. Forms
DA Form 3696, DA Form 3983 (Patients’ Trust Fund Authorization for Deposit or Withdrawal of Funds and
Valuables), DA Form 4128, and DA Form 4665 (Patients’ Trust Fund—Daily Summary Record) will be used to record
deposit and withdrawal of funds and valuables and central PTF accountability. DA Form 3983 and DA Form 4665 are
available on the APD Web site (www.apd.army.mil).
12–8. Procedures upon admission
When admitted to the hospital, the patient will be informed that the hospital assumes no liability or responsibility for
the loss of funds or valuables not placed in deposit. If the patient desires not to make a deposit, DA Form 3696 will be
prepared and the statement block indicating that no deposit is desired will be signed by the patient or witnessed, if the
patient is unable to sign, the form will be forwarded to the custodian. This procedure need not be utilized by those
facilities that have established other means of recording the patients’ desire to not use the PTF.
12–9. Audit
The PTF will be audited annually and at any other time deemed appropriate by the MTF commander.
Chapter 13
Injury and Illness Cases-Medical Affirmative Claims
13–1. General
a. Purpose.
(1) The Federal Medical Care Recovery Act, 42 USC 2651-2653, established the U.S. Government’s independent
right to recover the reasonable value of health care services provided at Government expense to an individual as a
result of an injury or illness incurred under circumstances creating a tort liability upon some third person.
(2) 10 USC 1095 provides authority for military health care facilities to collect the reasonable costs of health care
from health insurance and Medicare supplemental policies. 10 USC 1095 also authorizes the United States to recover
from automobile liability, medical payments, and personal injury protection or no-fault insurance. This chapter
establishes procedures in support of medical affirmative claims.
b. Applicability. The provisions of this chapter do not apply to battle casualties or to claims between Federal
agencies.
c. Recovery judge advocate (RJA). The term “RJA” as used in this chapter means the legal advisor in the Office of
the SJA assigned responsibility for asserting a medical affirmative claim. The RJA normally will work in the
designated judge advocate office that furnishes legal services to the Army hospital that provided the initial treatment or
hospitalization of an injured person entitled to medical care at Army expense. This is generally the judge advocate or
legal advisor of the command or installation supporting the Army MTF. Geographic areas assigned to an RJA generally
coincide with the geographic areas assigned to MEDDAC/MEDCEN commanders. The designated RJA is responsible
for asserting, pursuing, and settling claims arising from an injury or illness as a result of a recoverable accident or
incident. In cases where more than one treatment facility provides medical care to a beneficiary, the responsibility for
recovery may be transferred to another claims office, depending on which office has the most significant interest in a
particular claim (AR 27-20 and DA Pam 27-162).
d. Medical affirmative claim. A medical affirmative claim is a claim-other than a health insurance claim-asserted in
favor of the United States, for the reasonable value of health care services furnished at Government expense. These
claims include, but are not limited to, claims asserted against automobile and motorcycle insurance, including personal
injury protection and medical payment coverage, or uninsured/underinsured provisions; homeowner’s or renter’s
policies; products, premises, or general liability policies; and worker’s compensation (on-the-job injury) funds. These
claims were previously referred to as third party liability (TPL) claims and are commonly referred to as Federal
Medical Care Recovery Act claims.
e. Health care services. The term “health care services” includes all medical care furnished by or at the expense of
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