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.
Question | Answer |
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Form Name | Da Form 2984 |
Form Length | 1 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 15 sec |
Other names | entries, PROGNOSIS, prefix, NOTIFICATION |
VERY SERIOUSLY ILL/SERIOUSLY ILL/SPECIAL CATEGORY PATIENT REPORT
For use of this form, see AR
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PATIENT ADMINISTRATOR |
PERSON TO BE NOTIFIED |
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ADMINISTRATIVE OFFICER OF THE DAY |
5. RELATIONSHIP |
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1. DATE |
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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 |
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PLACED ON ROSTER |
PROGNOSIS: RECOVERY IS - |
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a. |
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VERY SERIOUSLY ILL |
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NOT EXPECTED |
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QUESTIONABLE
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SERIOUSLY ILL
QUESTIONABLE
EXPECTED
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SPECIAL CATEGORY (Specify)
CHANGE OF STATUS |
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d. |
SI TO VSI |
f. |
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e. |
VSI TO SI |
g. |
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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
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ACTION |
DATE |
HOUR |
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METHOD OF NOTIFICATION (Initial one) |
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TELEPHONE |
TELEGRAM |
LETTER |
IN PERSON |
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12. REPORT RECEIVED |
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13. |
PERSON (Same as Item 6) |
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14. |
INFORMATION OFFICE |
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NOTIFIED |
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17. UNIT COMMANDER |
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15. |
RED CROSS |
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16. |
CHAPLAIN |
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18. |
OTHER (Specify) |
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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. |
USAPA V1.01 |