746932 BERRY THOMAS K
M 39 WNH JEWISH
15 21 MAY 88
20 38053 44 59 HG FT SAM HOUSTON
DIR PARA 4-1 AR 40-3
MRS L B BERRY/W
7238 ESTATE FT SAM HOUSTON TX 822-3183/
BAMC FT SAM HOUSTON TX 78234
/6 JULY 83
LINE 1 = Register Number, Name, Grade
LINE 2 = Sex, Age, Race, Religion, Length of Service, ETS, Previous Admission
LINE 3 = FMP, SSN, Organization, Ward.
LINE 4 = Beneficiary Category, Unit Identification Code/Zip Code, Type of Case
LINE 5 = Source of Admission, Hour of Admission, Clinic Service
LINE 6 = Name/Relationship of Emergency Addressee
LINE 7 = Address of Emergency Addressee, Telephone, Date of Admission
LINE 8 = Name and Location of MTF
LINE 9 = Continuation of Line 7 (Indicated by /)
Figure 1-4. Sample nine-line addressograph plate (patient data card).
e. Other Embossed Plates. The admitting clerk will then prepare additional plates
for use with other clinical records.
(1) One of the additional plates is the inpatient identification plate. It
contains the name, grade, register number, family member prefix and social security
number, sex, and age.
(2) Another embossed plate is the nursing unit or clinic identification plate. It
contains the name and location of the MTF and the identification of the nursing unit, clinic,
or other functional area. The inpatient identification and nursing unit identification plate
may be combined into one plate or both used together to imprint information on clinical
record forms. Figure 1-5 contains sample plates and identifies the format in which the data