Da Form 2984 PDF Details

When a service member falls into the category of being very seriously ill, seriously ill, or is designated as a special category patient, the DA Form 2984 becomes a critical document. Designed under the guidelines set by AR 40-400, with the Office of The Surgeon General serving as the proponent agency, this form serves multiple vital functions within the military medical and administrative framework. It facilitates the communication between medical personnel and the administrative layers responsible for overseeing the wellbeing of service members. By detailing the patient's condition, from the initial diagnosis to their prognosis, and specifying whether recovery is expected, questionable, or not expected at all, it ensures that all relevant parties, including the patient administrator, the person designated to be notified, and various officers, are kept informed. The form also outlines the actions taken by medical officers, the method of notification for the person to be notified, and any changes in the patient's status, such as recovery, transfer, or, in regrettable cases, death. Additionally, it engages other support systems within the military, such as the Red Cross and chaplain services, signaling a holistic approach to the care and support of the patient and their family. The DA Form 2984 is not only a bureaucratic necessity but a means of ensuring that those who serve are not alone in their time of need, reaffirming the military's commitment to its members' health and welfare.

QuestionAnswer
Form NameDa Form 2984
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesentries, PROGNOSIS, prefix, NOTIFICATION

Form Preview Example

VERY SERIOUSLY ILL/SERIOUSLY ILL/SPECIAL CATEGORY PATIENT REPORT

For use of this form, see AR 40-400; the proponent agency is the Office of The Surgeon General

TO:

 

PATIENT ADMINISTRATOR

PERSON TO BE NOTIFIED

 

 

 

ADMINISTRATIVE OFFICER OF THE DAY

5. RELATIONSHIP

 

 

 

 

 

1. DATE

 

 

2. HOUR

6. NAME AND ADDRESS

3. RELIGION OF PATIENT

4. WARD

ACTION TAKEN BY MEDICAL OFFICER

7. BRIEF DIAGNOSIS (Use lay terminology)

8. STATUS OF PATIENT

 

 

 

 

PLACED ON ROSTER

PROGNOSIS: RECOVERY IS -

 

 

 

 

 

a.

 

VERY SERIOUSLY ILL

 

 

NOT EXPECTED

 

 

 

 

 

 

QUESTIONABLE

b.

SERIOUSLY ILL

QUESTIONABLE

EXPECTED

c.

SPECIAL CATEGORY (Specify)

CHANGE OF STATUS

 

d.

SI TO VSI

f.

 

e.

VSI TO SI

g.

 

RECOVEREDh.

TRANSFERREDi.

DIED

ADDITIONAL SPECIAL CATEGORY (Specify in remarks)

9. REMARKS

10. TYPED OR PRINTED NAME OF MEDICAL OFFICER

11. SIGNATURE

ACTION TAKEN BY PATIENT ADMINISTRATOR OR ADMINISTRATIVE OFFICER OF THE DAY

 

 

ACTION

DATE

HOUR

 

METHOD OF NOTIFICATION (Initial one)

 

 

 

 

 

 

 

 

 

TELEPHONE

TELEGRAM

LETTER

IN PERSON

 

 

 

 

 

12. REPORT RECEIVED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13.

PERSON (Same as Item 6)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14.

INFORMATION OFFICE

 

 

 

 

 

 

NOTIFIED

 

 

 

 

 

 

 

17. UNIT COMMANDER

 

 

 

 

 

 

 

15.

RED CROSS

 

 

 

 

 

 

 

16.

CHAPLAIN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18.

OTHER (Specify)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9. REMARKS

PATIENT'S IDENTIFICATION (For typed or written entries give: Name - last, first, middle; grade; family member prefix; SSN)

20.TYPED OR PRINTED NAME OF PATIENT ADMINISTRATOR OR ADMINISTRATIVE OFFICER OF THE DAY

21. SIGNATURE

DA FORM 2984, APR 74

EDITION OF 1 MAY 65 WILL BE USED UNTIL EXHAUSTED.

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