NOTE: Fields, columns, and items corresponding with these examples are found on
DA Form 2985 (Admission and Coding Information) which initiates the documenting of
SOURCES OF DATA
purpose form used as a patient admission information document and coding transcript
in Army MTFs not having automated admission and disposition/clinical records
processing. Fields on the DA Form 2985 have been arranged so that most of the
demographic and administrative data are on page 1 of the three-page form. This allows
page 1 of the form to be completed in its entirety once disposition of the patient is made.
Information on page one of the form is used to generate management reports.
NOTE: DA Form 2985 is known as the A&C Form.
b. The A&C Form is also designed so that most of the information needed to
complete page 1 is derived from the patient interview at the time of admission. The
remaining information must be obtained from the Inpatient Treatment Record Cover
a. Nonautomated hospitals should complete applicable fields of the A&C Form in
an original and two legible copies at the time of admission.
b. Codes must be written legibly to avoid errors in data reduction. Alphabetical
characters must be printed as capital block letters; these codes do not contain lower
case letters. Zero must always be written . The alphabetical characters "O," "S," "U,"
and "Z," must always be written as " O," " S," "U," and " Z."
c. Maintain the original and legible copies of the A&C Form in a suspense file
while the patient remains in an inpatient status.
d. At the time of disposition, remove the original and legible copies of the
A&C Form from the suspense file and complete the applicable fields on Page 1 of the
e. Forward the A&C Form to the Medical Records Administration Branch for
filing in the patient's terminal digit file folder to await completion of the Inpatient
Treatment Record (ITR).
f. Upon completion of the ITR, remove the A&C Forms from the patient's
terminal digit file folder and complete pages 2 and 3 of the form.
g. File the original A&C Form (DA Form 2985) in the patient's ITR.