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DA Form 4665. Patients` Trust Fund - Daily Summary Record

DA Form 4665. Patients` Trust Fund - Daily Summary Record

Form DA 4665 is used as a Patients' Trust Fund - Daily Summary Record in medical facilities within the Army. This form serves as a daily summary record of financial transactions related to patients' trust funds, which are used to manage and track patients' personal funds while they are under medical care.

The form consists of sections where financial transactions, such as deposits and withdrawals, are recorded for each patient's trust fund. It includes details of the patient's name, medical record number, the amount of money involved, and the purpose of the transaction. Additionally, the form may include sections for balancing and verifying the accuracy of the financial records.

Important fields in this form include accurate documentation of financial transactions and proper balancing of patients' trust funds. Accurate completion of this form is crucial to ensure the appropriate management of patients' personal funds and to maintain transparency and accountability in financial matters within the medical facility.

Application Example: A hospital ward receives deposits from patients and makes withdrawals on their behalf for personal expenses. The finance officer completes Form DA 4665, recording each patient's financial transactions for the day, including the amounts deposited and withdrawn. The completed form is then used to reconcile the financial records and ensure that each patient's trust fund is accurately maintained. By doing so, the medical facility safeguards patients' personal funds and complies with financial regulations.

Individuals filling out this form should consider any additional supporting documents, such as receipts or transaction reports, that may be required to verify the financial transactions.

Related Forms: There may not be direct alternatives to Form DA 4665, as it serves as a specialized daily summary record for patients' trust funds. However, there might be other forms related to financial records and transactions used in similar medical settings.