For use of this form, see AR 40-400; the proponent agency is OTSG.
Status of patient: very seriously ill, seriously ill, non seriously ill or special category (specify).
Prognosis: recovery is questionable, expected or not expected.
Change of status: SI to VSI, VSI to SI, transferred, recovered or died.
Method of notification: initial one of telephone, telegram, letter or in person.
Report received: person (same as item 6), information office, Red Cross, chaplain, unit commander or other (specify).
| Question | Answer |
|---|---|
| Form Name | DA Form 2984 |
| Form Length | 1 page |
| Fillable? | Yes |
| Fillable fields | 49 |
| Avg. time to fill out | 9 min |
| Edition | APR 2009 |
| Proponent agency | OTSG (AR 40-400) |
| Previous editions | Obsolete |
| Other names | DA Form 2984, DA 2984, DA2984, Very Seriously Ill/Seriously Ill/Special Category Patient Report |
| Official source | DA Form 2984 (Rev APR 2009), U.S. Army |