REQUIREMENT: For items 14-21, match the extracts or statements in Column A to the
correct plates as listed in Column B. Place a, b, or c in space provided to the left of
Column A.
COLUMN A
COLUMN B
14.
Embossed with three lines of data:
a. Admitting Plate
Name of MTF
Location of MTF
Identification of Clinic
b. Clinic Identification Plate
15.
Embossed to show nine lines of
patient identification data in the
c. Inpatient Identification
sequence indicated by DA Form
Plate
2985.
16.
Used to imprint information on DA
Form 3647-1.
17.
Embossed with three lines of data:
Name, Grade
Register Number, FMP, SSN
Sex, Age
18.
Used to imprint label for the Inpatient
treatment record folders.
19.
May be combined with the nursing unit
plate to imprint information on clinical
record forms except the inpatient
treatment record cover sheet.
20.
Includes information on name and
address of emergency addressee.
21.
Used to prepare the admission and
disposition report.
MD0752
1-55