(16) Block 16.
(a) Check appropriate box.
(b) Enter date and time.
(17) Block 17.
(a) Check appropriate box of service provided.
(b) Write in signature of chaplain providing service.
NOTE: This block will be completed by the United Ministry Team.
DISPOSITION OF THE FMC
a. For Patients Admitted and Discharged and CRO Cases. The original is
used to complete DA Form 2985 (Admission and Coding Information) for the Individual
Patient Data System (IPDS) (see fig 4-2). IPDS is covered in detail in Subcourse
MDO753. The FMC may be forwarded to higher headquarters for coding or coding may
be done locally. If coded locally, attach it to DA Form 2985 and forward both forms to
higher headquarters or the designated medical records activity within the command.
b. For Transfer Patients. Forward original FMC with the patient to the
receiving hospital where the FMC becomes part of the Inpatient Treatment Record
c. For Outpatients. File the original FMC in the patient's Health Record.
FMCs for outpatients do not require coding.
Destroy locally after three months.
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