USE OF DD FORM 1380, US FIELD MEDICAL CARD

SAMPLE FORMAT

General

The FMC (DD Form 1380) (AR 40-66) is used to record basic patient identification data and to describe the problem requiring medical attention and the medical care provided. The FMC is made so that it can be attached to the casualty.

This paragraph implements STANAGs 2132 and 2350 and QSTAGs 230 and 470.

Use of the US Field Medical Card

The combat medic first attending battle casualties will initiate DD Form 1380 by completing blocks 1, 3, 4, 7, and 9 and by entering as much information in the remaining blocks as time permits. The combat medic enters his initials in the far side of the signature block (Block 11).

NOTE:  1. The ambulance crew must be familiar with completing this form and should maintain a stock of them in the ambulance. The ambulance crew may be the first medical personnel to attend to a casualty.

2. When morphine is administered to a casualty in the field environment the dose, ZULU time, date, route or entry, and name of the drug must be entered onto the DD Form 1380. Additionally, the combat medic (or other health care provider) must mark the casualty with the letter "M" and the hour of injection (such as "M 0830") on the forehead with a skin pencil or another semi-permanent marking substance. The empty syrette, injection device, or its envelope should be attached to the casualty's clothing.

Aid stations record medical care provided on the DD Form 1380 any time that the aid station is operational and does not have access to the patient's health record (HREC) or outpatient treatment record (OTR).

Treatment teams providing Echelon II medical care use the DD Form 1380 any time that care is provided and the patient's HREC is not readily available. If a patient is treated in a holding section or is expected to return for additional treatment or evaluation, an OTR may be initiated using standard medical record forms. The OTR need not be filed in a DA Form 3444-series record. When the patient is returned to duty or when treatment and evaluation are completed, the medical officer summarizes care provided on DD Form 1380 and this form is disposed of according to the procedures outlined in AR 40-66. When the patient is evacuated, treatment will be summarized on DD Form 1380 and it (along with all forms and records initiated) will accompany the patient during evacuation.

Medical treatment facilities providing Echelons III and IV care will use DD Form 1380 to record outpatient care provided when the patient's HREC is not readily available (as stated in a, b, and c above.)

Preparation of the Field Medical Card

A medical officer will complete DD Form 1380 or supervise its completion. When DD Form 1380 has been initiated by a medic, the supervising AMEDD officer will complete, review, and sign the DD Form 1380.

In the TO, DD Form 1380 will be prepared for any patient treated at BASs, clearing stations, and MTFs and may also be used for carded for record only (CRO) cases. When evacuated, the DD Form 1380 will be attached to the patient's clothing, where it will remain until the patient arrives at a hospital or RTDs. If the patient dies, DD Form 1380 will remain attached to the body until internment, when it is removed. If the body cannot be identified, the registration number given the remains by the Mortuary Affairs element will be noted on DD Form 1380.

Under combat conditions, DD Form 1380 for patients being evacuated may be only partially completed. Otherwise, all entries should be completed as fully as possible.

All abbreviations authorized for use on DA Form 3647 may also be used on DD Form 1380.

However, except for those listed below, abbreviations may not be used for diagnostic terminology.

Abr W - abraded wound.

Cont W - contused wound.

FC - fracture (compound) open.

FCC - fracture (compound) open comminuted.

FS - fracture simple (closed).

LW - lacerated wound.

MW - multiple wounds.

Pen W - penetrating wound.

Perf W - perforating wound.

SL - slight.

SV - severe.

The FMC may also be used for CRO cases. Certain cases not admitted to an MTF are CRO.

For CRO cases, DA Form 3647 or the FMC is prepared and a register number assigned. When DA Form 3647 is used, Items 7, 10, 14, 24, 27, 30, and the name of the admitting officer need not be completed.

When the FMC is used, Item 11 need not be completed.

Figure C-1 provides a sample DD Form 1380 completed by the combat medic.

Figure C-2 is a sample of reassessment accomplished at the BAS.

Instructions for the completion of DD Form 1380 are contained in Table C-1.

 

Officer and enlisted grade structure to be used in completing this form are contained in Table C-2.


Disposition of Field Medical Cards

In a CZ, if the DD Form 1380 is generated but the patient is not admitted to a hospital, the form will be sent to the medical C2 headquarters or the command surgeon for statistical coding as specified in the TSOP. Once the DD Form 1380 is coded, it is forwarded for inclusion in the individuals records.

(Specific addresses and disposition instructions are provided in AR 40-66 and AR 25-400-2).

When a patient is evacuated and upon his arrival at a hospital, the DD Form 1380 will be used to prepare the inpatient treatment record (ITR). The DD Form 1380 will then become part of the ITR.

The original DD Form 1380 used to record outpatient treatment in peacetime operations or during training exercises will be forwarded to the custodian of the patient's HREC or OTR for inclusion in the record.

Field Medical Record Jacket

The Field Medical Record Jacket (DA Form 4006) may be used as an envelope for the DD Form 1380. To keep the jacket from being opened while the patient is in transit, pertinent personnel and medical data on the patient may be recorded on the outside. The movement of the patient may also be recorded. When the jacket has been so used, it becomes a part of the ITR.