4. Fields on DA Form 2985 have been arranged so that most of the demographic and
administrative data are on page __________ of the three-page form.
5. Codes on the A&C Form must be written legibly. Alphabetical characters must be
printed as ___________letters. Zero must always be written __________.
6. Nonautomated sites/hospitals should complete applicable fields of the A&C Form in
an original and _________legible copies at the time of admission and maintain these
copies in a suspense file while the patient remains in an inpatient status.
7. At the time of disposition, copies of the patient's A&C Form are removed from the
suspense file and applicable fields on ______ are completed by the Admissions and
8. After disposition, the A&C Form is forwarded to the _______
_____________________for filing in the patient's terminal digit file folder to await
completion of the Inpatient Treatment Record (ITR).
9. Upon completion of the Inpatient Treatment Record (ITR), the original and copies of
the A&C Form are removed from the patient's terminal digit file folder and ______ ___
are completed by the Medical Records Administration Branch personnel.
10. In the following example, 1. REPORTING MTF is a ________ on the A&C Form.
1. REPORTING MTF