d. DA Form 3155 (MSA Record). DA Form 3155 (see figure 4-4) is used to
record medical services account collections applicable to accounts receivable and cash
sales. Accountability is maintained for each day's activities and for each calendar month
and entries include the daily undeposited balance.
Figure 4-4. DA Form 3155 (MSA Cash Record).
e. DA Form 3156 (Statement of MSA Accountable Patient Days and
Reimbursements Earned). DA Forms 3156 (see figure 4-5) is used by the MSAO to
reconcile patient days to DA Form 2789 (Medical Summary Report) and to compute
reimbursements earned for each patient category. DA Form 3156 is prepared at the end
of each month after all charges and credits have been posted to the medical service