22. SITUATION: You are working in the admission and disposition office of the
Eisenhauer Army Medical Center, Fort Gordon, GA 30905. The date is 6 July 199X.
SFC Raymond E. Jones enters your office at 1315 hour and hands you a DA Form 2985
requesting admission to the MTF. You will verify his need for admission and his eligibility,
obtain a register number, and collect his patient information You will then enter the
appropriate information on the register number log and the DA Form 2985. Refer to the
tables in this lesson for some of the information.
SFC Jones is a 34 year old black male , an E-7, is married, has two children, and
lives at 1420 River Road, Augusta, GA, 30915, telephone number is 245-3315. He is a
member of the First Methodist Church. His social security number is 345-13-4039 and has
been in the Army for 13 years with an ETS of 3 March 199X. His unit is HHC, HQ CMMS.
He has never been hospitalized at Fort Gordon and is not on flying status. He is a medical
specialist in the US Army. SFC Jones is going to have general surgery for an
appendectomy. His wife, Jane W., same address and telephone number, is his
emergency addressee. The authority for admission is paragraph 4-1, AR 40-3.
REGISTER
NAME
RANK
SSN
ORGANIZATION
DIS/ INJ
WARD
NUMBER
LAST
FIRST
MIDDLE INITIAL
173624
173625
173626
173627
173628
173629
173930
Register Number Log (Exercise 22).
MD0752
1-56
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