Da Form 2984 is a Department of the Army form that is used to request excess property from other organizations. This form can be used to request materials, supplies, or equipment from other agencies or organizations. The form must be completed and submitted by the organization requesting the excess property. The receiving organization will then review the request and make a determination on whether or not to approve the request. Organizations should ensure that they are authorized to receive the requested property before submitting a request. The Department of Defense has specific regulations for how this process should be executed, so it is important to understand and follow these guidelines when submitting a request. It is also important to note that only authorized users can submit requests for excess property through DA Form 2984.
| 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 |