Af Form 3899a

Af Form 3899a A AF IMT Form 3899A is used by medical personnel who are involved in patient movement Q What information is recorded on AF IMT Form 3899A A AF IMT Form 3899A records information such as patient s name diagnosis treatment mode of transportation and remarks

AF IMT 3899 20060819 V1 REVERSE 1 NAME Last First Middle Initial 2 GRADE 3 SSN PERMANENT MEDICAL RECORD 4 ALLERGIES 5 ORIGINATING MTF 6 DESTINATION MTF no patient will self medicate PATIENT MOVEMENT PHYSICIAN ORDERS with the following medications MEMORANDUM FOR THE RECORD AF IMT 3899 20060819 V1 TPMRC W Modified Overprint PERTINENT CLINICAL HISTORY Transfer Summary Per DAFI 48 107V3 The attending provider will sign the AF Form 3899 consultation with the TPMRCW TVFS has been completed the patient condition is stable and cleared for Flight For providers and staff leave this field blank

Af Form 3899a

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Af Form 3899a
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AF Form 3899C Patient Movement Physical Assessment AF Forms
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AF IMT Form 3899A Patient Movement Record Progress Note TemplateRoller

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A AF IMT Form 3899A is used by medical personnel who are involved in patient movement Q What information is recorded on AF IMT Form 3899A A AF IMT Form 3899A records information such as patient s name diagnosis treatment mode of transportation and remarks

AF Form 3899C Patient Movement Physical Assessment AF Forms
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AF IMT 3899 20060819 V1 REVERSE 1 NAME Last First Middle Initial 2 GRADE 3 SSN PERMANENT MEDICAL RECORD 4 ALLERGIES 5 ORIGINATING MTF 6 DESTINATION MTF no patient will self medicate PATIENT MOVEMENT PHYSICIAN ORDERS with the following medications MEMORANDUM FOR THE RECORD

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AF IMT 3899 20060819 V1 PERTINENT CLINICAL HISTORY Transfer Summary Per AFI 48 307V3 The attending provider will sign the AF Form 3899 consultation with the TPMRCW TVFS has been completed the patient is stable and cleared for Flight For providers and staff leave this field blank Air Evac admin staff will insert this number AF 3899L 20140107 V2 0 PATIENT MOVEMENT RECORD ENROUTE CRITICAL C RE DATA PROTECTED BY PRIVACY ACT OF 1974 PERMANENT MEDICAL RECORD 1 Name 2 SSN 3 Cite 4 Age 5 Sex 6 WT 7 HT 8 Allergies 9 Precedence10 Date Time 11 Originating facility 12 Destination Facility 13 AC Tail 14 AE CCAT unit 15 CCAT pts

Office of Primary Responsibility OPR using AF Form 847 Recommendation for Change of Publication route the AF Form 847 through the appropriate chain of command and parent Major AF Form 3899A Patient Movement Record Progress Note Front and Back 22 4 4 AF Form 3899B Patient Movement Physician Orders Continue flow sheet on the backofthis form AFFORM3899M 20140813 PATIENT MOVEMENTRECORD PCA PNB EPIDURAL HAND OFF DATAPROTECTEDBY PRIVACYACTOF 1974 PERMANENTMEDICALRECORD ASSESSMENT PROGRESS Continued NAME Last First Middle Initial DOB STATUS SERVICE CITE PATIENT ID

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AF Form 3899B Patient Movement Physician Orders AF Forms
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The following documents AF Form 3899 Aeromedical Evacuation Patient Record DA Form 3981 Request for Patient Transfer and a Narrative Summary to include patient s history and current condition need to be completed and submitted to the Air Evacuation so that the patient can be regulated in TRAC2es Patients cannot be regulated without the AF Form 3899A also known as the Patient Movement Record Progress Note is a crucial document in the medical field that ensures the smooth and safe transportation of patients This form captures pertinent information about the patient s condition treatment received and any adjustments made during transit

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Af Form 3899a - Continue flow sheet on the backofthis form AFFORM3899M 20140813 PATIENT MOVEMENTRECORD PCA PNB EPIDURAL HAND OFF DATAPROTECTEDBY PRIVACYACTOF 1974 PERMANENTMEDICALRECORD ASSESSMENT PROGRESS Continued NAME Last First Middle Initial DOB STATUS SERVICE CITE PATIENT ID