DA Form 3696. Patient`s Deposit Record

Form DA 3696 is a record form used to document deposits made by patients in a military medical facility. This form helps track and manage patient deposits, ensuring transparency and accountability.

The form consists of sections where the patient's personal information, deposit details, and signature can be recorded. It may include columns or tables to record the date of deposit, amount deposited, purpose of the deposit, and any remarks or notes.

Important fields in this form include the patient's personal information, deposit details such as the date and amount deposited, and any relevant remarks or notes. It is crucial to accurately record the information to maintain an accurate account of patient deposits.

Application Example: Military medical facilities can use this form to document patient deposits made within the facility. The form should be completed with accurate and complete information about the patient, deposit details, and any relevant remarks. This form helps track patient deposits, ensure transparency, and facilitate proper management of financial transactions within the military healthcare system.

Related Forms: Depending on the specific context or purpose, other forms related to financial transactions, patient billing, or revenue management may exist within the military medical system.