4-46. FOR LOCAL USE.
The reporting MTF will determine entries made in this area.
EXAMPLE:
FOR LOCAL USE
FX HUMERUS, OPEN
TRIPPED AND FELL ON RT
OPEN REDUCTION WITH
ARM IN HOME AT 1400
INTERNAL FIXATION DEVICE
ON DATE OFADMISSION
4-47. ADMITTING OFFICER
a. Source of data. Self-explanatory.
b. Enter the name of the physician or other care provider authorizing admission.
If the A&C Form is used as the admission authorization, the admitting officer should
sign in this area.
EXAMPLE:
ADMITTING OFFICER (Signature, as required)
Ellis P. Brewster, COL, MC
4-48. SIGNATURE OF ADMITTING CLERK
a. Source of data. Self-explanatory.
b. The admitting clerk should sign in this area.
MD0753
4-50