entries for fund transactions. Each transaction requires the date of transaction; amount of
deposit or amount of withdrawal; and the signature of the person receiving the deposit or
the funds withdrawal. The first signature block on the form is signed by the patient to
indicate that he does or does not wish to make a deposit and/or to indicate that he has
been informed that any possessions which he does not deposit are retained at his own
risk. The second signature block at the top of the form is for use when all funds and
valuables are withdrawn and the account is closed, i.e., prior to the patient's departure
from the hospital.
(2) The bottom of the form (see figure 5-2) is used to list valuables deposited.
The information entered includes: number (quantity of like items); description; date and
signature of custodian when deposit is made; and date and signature of patient or
responsible individual when a withdrawal is made. For articles of intrinsic value, the
description is made without an attempt to evaluate it; for example, "ring, silver color with
clear stone" is used as a description instead of "silver ring with diamond stone." If an
article has a serial number, the serial number is included in the description if it can be
seen without dismantling the article. Valuables are kept in sealed containers such as
envelopes, cloth bags, or appropriate containers. The containers are clearly marked with
the patient's name and account (register) number and are numbered (e.g., "No. 1 of 1,"
"No. 1 of 2," "No. 2 of 2," etc.) Valuables too large to be inserted in an envelope may be
kept in any appropriate container, properly labeled, or wrapped and tagged with a DD
Form 599 (see figure 5-3).