The Department of the Army has released a new Form 5181 R, which is now available on the DA Forms website. This new form is used to request reimbursement for relocation expenses incurred by civilian employees. The form must be completed and submitted within 90 days of the employee's arrival at the new duty station. Reimbursement may be requested for costs incurred during both the move and the period of temporary lodging. This form should be filled out accurately and completely to ensure that employees receive the proper reimbursement for their relocation expenses. For more information on what expenses are covered, please review Chapter 10 of Army Regulation 550-5, "Relocation Allowances."
| Question | Answer |
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| Form Name | Da Form 5181 R |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | adtmc army 2019, adtmc app, adtmc 2019, adtmc pdf |
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SCREENING NOTE OF ACUTE MEDICAL CARE
For use of this form, see AR
TIME PATIENT DEPARTS UNIT
(From DD Form 689)
SCREENER LOCATION
TIME PATIENT ARRIVES |
TIME ENCOUNTER BEGINS |
TIME PATIENT LEAVES |
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SCREENER LOCATION
CHIEF COMPLAINT
DURATION
PATIENT RESIDENCE |
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VITAL SIGNS |
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( ) BARRACKS |
( ) POST HOUSING |
TEMPERATURE |
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ALLERGIES |
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( ) OFF POST |
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) TRANSIENT |
PULSE |
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BP |
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RESP |
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FIRST VISIT FOR THIS COMPLAINT ( |
) YES ( ) NO IF NO, WAS RETURN SCHEDULED/REQUESTED BY CARE PROVIDER? |
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( ) YES ( ) NO |
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ALGORITHM/CODE |
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ALGORITHM/CODE |
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ALGORITHM SUMMARY |
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ALGORITHM SUMMARY |
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COMMENTS (Reasons for referral, method of referral, hospital appointments,
PATIENT'S IDENTIFICATION (Use mechanical imprint if available, for typed or written entries give: Name, SSN, Unit, Sex, Birthdate and
Duty Phone)
FINAL DISPOSITION |
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I - PHYSICIAN STAT |
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IV - SELF CARE PROTOCOL |
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II - PA STAT |
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) V - HOSP CLINIC REFERRAL |
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) III - PA |
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AIDMAN'S SIGNATURE & CODE
AUDITOR'S INITIALS & DATE
DA FORM |
PREVIOUS EDITIONS OF THIS FORM ARE OBSOLETE. |
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RECORD OF ACUTE MEDICAL CARE
(Entries on this record should be restricted to further evaluation and treatment of complaint(s) screened)
DATE
2ND CARE LOCATION
TIME PATIENT ARRIVES
TIME ENCOUNTER BEGINS
TIME PATIENT LEAVES
SIGNATURE OF HEATH CARE PROVIDER
SIGNATURE OF MEDICAL SUPERVISOR
AUDITOR'S INITIALS AND DATE
SPECIAL INSTRUCTIONS
This form will be utilized in lieu of SF 600 (Health
REVERSE OF DA FORM |
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