AR 40–3

112 Pages·2013·1.29 MB·English

Army Regulation 40–3
Medical Services
Medical,
Dental, and
Veterinary
Care
Headquarters
Department of the Army
Washington, DC
23 April 2013
UNCLASSIFIED
SUMMARY of CHANGE
AR 40–3
Medical, Dental, and Veterinary Care
This major revision, dated 23 April 2013--
o Requires that The Surgeon General appoint the Consultant, Blood Program and
Director, Army Blood Program (para 5-2a(6)).
o Adds qualifications for the Director, Army Blood Program (para 5-2d(1)).
o Adds qualifications for the Chief, Blood Services and for Blood Donor Center
officers in charge (para 5-2f(2)).
o Clarifies that the regional medical command blood manager has overall
responsibility for managing credits throughout their respective region (para
5-2f(15)).
o Requires commanders to ensure that reservists mobilized in support of the
Army Blood Program are used in the appropriate blood program position (para 5-
2f(16)).
o Provides guidance on establishing or terminating an Army Medical Department
library property account (para 7-10).
o Revises the mission of the nutrition care division (para 8-2).
o Expands duties of the nutrition care divisions’ noncommissioned officers in
charge (para 8-4c).
o Adds military treatment facility staff to those authorized to eat in a
military treatment facility’s nutrition care division (para 8-5a).
o Revises nutrition care division documentation requirements (paras 8-5c, 8-
9e, and 8-16).
o Requires DD Form 1544 (Cash Meal Payment Book) for use with manual cash
collections (para 8-6c).
o Revises payment requirements for ambulatory patients (para 8-20).
o Authorizes foreign national embassy staff to be listed for transplantation
through the Army-Navy Transplant Service (para 9-1b(7)).
o Updates medical and administrative living donor requirements (paras 9-1b(4)
and 9-1c(1)).
o Defines and separates from kidney donation requirements the provisions for
living hepatic donation (para 9-2d(5)(b)).
o Revises guidance on recording and reporting medication errors (para 11-9b).
o Revises guidance on controlled substances (para 11-10 and app B).
o Adds guidance relevant to dispensing procedures (para 11-14e).
o Revises guidance on refill prescriptions from other medical treatment
facilities (para 11-14g).
o Specifies the age at which an accompanied child can pick up prescriptions
(para 11-14h).
o Updates guidance on pharmacy support to mobilizing and deploying personnel
(para 11-26).
o Revamps pharmacy and medication automation procedures (para 11-28).
o Clarifies cardiac life support training requirements for boarded emergency
medicine physicians (tables 13-1 and 13-2).
o Incorporates the Laboratory Response Network into medical laboratory
management (chap 14).
o Adds food defense to veterinary services (para 15-2).
o Makes administrative revisions (throughout).

Headquarters *Army Regulation 40–3
Department of the Army
Washington, DC
23 April 2013 Effective 23 May 2013
Medical Services
Medical, Dental, and Veterinary Care
Proponent and exception authority. B l a n k F o r m s ) d i r e c t l y t o T h e S u r g e o n
The proponent of this regulation is The G e n e r a l o f t h e A r m y , 7 7 0 0 A r l i n g t o n
Surgeon General. The proponent has the B o u l e v a r d , F a l l s C h u r c h , V A
authority to approve exceptions or waivers 22042–5142.
to this regulation that are consistent with
controlling law and regulations. The pro- Committee management. AR 15-1 re-
ponent may delegate this approval author- quires the proponent to justify establish-
ity, in writing, to a division chief within i n g / c o n t i n u i n g c o m m i t t e e ( s ) , c o o r d i n a t e
the proponent agency or its direct report- draft publications, and coordinate changes
ing unit or field operating agency, in the in committee status with the U.S. Army
grade of colonel or the civilian equivalent. Resources and Programs Agency, Depart-
Activities may request a waiver to this ment of the Army Committee Manage-
regulation by providing justification that
m e n t O f f i c e ( A A R P - Z A ) , 9 3 0 1 C h a p e k
includes a full analysis of the expected
Road, Building 1458, Fort Belvoir, VA
benefits and must include formal review
22060-5527. Further, if it is determined
by the activity’s senior legal officer. All
t h a t a n e s t a b l i s h e d “ g r o u p ” i d e n t i f i e d
H i s t o r y . T h i s p u b l i c a t i o n i s a m a j o r waiver requests will be endorsed by the
within this regulation, later takes on the
revision. commander or senior leader of the requ-
characteristics of a committee, as found in
e s t i n g a c t i v i t y a n d f o r w a r d e d t h r o u g h
S u m m a r y . T h i s r e g u l a t i o n , a d d r e s s i n g the AR 15-1, then the proponent will fol-
t h e i r h i g h e r h e a d q u a r t e r s t o t h e p o l i c y
multiple medical programs, has been re- proponent. Refer to AR 25–30 for specific l o w a l l A R 1 5 - 1 r e q u i r e m e n t s f o r e s -
vised to update policy on the Army Blood guidance. tablishing and continuing the group as a
Programs, medical libraries, nutrition care committee.
management, The Army Organ Transplant Army internal control process. This
a n d O r g a n / T i s s u e D o n a t i o n P r o g r a m s , regulation contains internal control provi- Distribution. This publication is availa-
p h a r m a c y a n d m e d i c a t i o n m a n a g e m e n t , s i o n s a n d p r o v i d e s a n I n t e r n a l C o n t r o l ble in electronic media only and is in-
emergency medical services, medical lab- Evaluation for use in evaluating key inter- tended for command levels A, B, C, D,
oratory management, veterinary care, and nal controls (see appendix C). and E for the Active Army, the Army
air ambulance vehicles. S u p p l e m e n t a t i o n . S u p p l e m e n t a t i o n o f National Guard/Army National Guard of
Applicability. This regulation applies to this regulation and establishment of com- t h e U n i t e d S t a t e s , a n d t h e U . S . A r m y
t h e A c t i v e A r m y , t h e A r m y N a t i o n a l mand and local forms is prohibited with- Reserve.
Guard/Army National Guard of the United o u t p r i o r a p p r o v a l f r o m T h e S u r g e o n
States, and the U.S. Army Reserve, unless G e n e r a l o f t h e A r m y , 7 7 0 0 A r l i n g t o n
otherwise stated. It also applies to medical B o u l e v a r d , F a l l s C h u r c h , V A
d e p a r t m e n t a c t i v i t i e s , m e d i c a l c e n t e r s , 22042–5142.
dental activities, veterinary activities, and Suggested improvements. Users are
other Army Medical Department organi- invited to send comments and suggested
zations. This publication is applicable dur- improvements on DA Form 2028 (Recom-
ing mobilization. m e n d e d C h a n g e s t o P u b l i c a t i o n s a n d
Contents (Listed by paragraph and page number)
Chapter 1
Introduction, page 1
Purpose (cid:129) 1–1, page 1
References (cid:129) 1–2, page 1
Explanation of abbreviations and terms (cid:129) 1–3, page 1
*This regulation supersedes AR 40–3, dated 22 February 2008.
AR 40–3 (cid:129) 23 April 2013 i
UNCLASSIFIED
Contents—Continued
Responsibilities (cid:129) 1–4, page 1
Chapter 2
Advance Directives, Do-Not-Resuscitate, and Withhold/Withdraw Orders, page 1
Introduction (cid:129) 2–1, page 1
Responsibilities (cid:129) 2–2, page 1
Policy (cid:129) 2–3, page 1
Documentation (cid:129) 2–4, page 2
Review (cid:129) 2–5, page 2
Abatement decisions for patients with decisionmaking capacity (cid:129) 2–6, page 2
Abatement decision for incapable patients (cid:129) 2–7, page 2
Education (cid:129) 2–8, page 3
Active duty patients (cid:129) 2–9, page 3
Additional guidance (cid:129) 2–10, page 3
Chapter 3
Army Aviation Medicine Program and Medical Care of Aviation Personnel, page 3
Program concept (cid:129) 3–1, page 3
Responsibilities (cid:129) 3–2, page 3
Aeromedical physician assistants (cid:129) 3–3, page 4
Flight medical aidman (cid:129) 3–4, page 4
Flight surgeon clinical duties (cid:129) 3–5, page 4
Flight surgeon nonclinical duties (cid:129) 3–6, page 5
Supervising medical care for aviation personnel (cid:129) 3–7, page 5
Fitness for flying duty (cid:129) 3–8, page 6
Federal Aviation Administration medical examinations and certificates (cid:129) 3–9, page 6
Chapter 4
Auditory Evaluation and Hearing Aids, page 7
Auditory evaluation and treatment facilities (cid:129) 4–1, page 7
Disposition of patients with hearing impairment (cid:129) 4–2, page 7
Procurement of hearing aids (cid:129) 4–3, page 7
Records of hearing aid issue (cid:129) 4–4, page 7
Repair and replacement of hearing aids (cid:129) 4–5, page 7
Accountability and responsibility (cid:129) 4–6, page 8
Chapter 5
Army Blood Programs, page 8
General (cid:129) 5–1, page 8
Responsibilities (cid:129) 5–2, page 8
Policy (cid:129) 5–3, page 11
Organization (cid:129) 5–4, page 13
Individual blood group and type (cid:129) 5–5, page 13
Disposition of blood products (cid:129) 5–6, page 14
Exchange or sale of outdated blood plasma (cid:129) 5–7, page 14
Chapter 6
Dental Care, page 14
General (cid:129) 6–1, page 14
Authorization of care (cid:129) 6–2, page 15
Dental care priority (cid:129) 6–3, page 15
Dental examinations and screenings (cid:129) 6–4, page 15
Dental readiness classification (cid:129) 6–5, page 15
Dental appointments (cid:129) 6–6, page 16
Audit system (cid:129) 6–7, page 16
ii AR 40–3 (cid:129) 23 April 2013
Contents—Continued
Preventive dentistry (cid:129) 6–8, page 16
Chapter 7
Medical Libraries, page 16
Purpose (cid:129) 7–1, page 16
Applicability (cid:129) 7–2, page 16
Objectives (cid:129) 7–3, page 17
Responsibilities (cid:129) 7–4, page 17
Directives (cid:129) 7–5, page 18
Policy (cid:129) 7–6, page 19
Personnel (cid:129) 7–7, page 20
Collection development (cid:129) 7–8, page 21
Management reporting (cid:129) 7–9, page 21
Accountability (cid:129) 7–10, page 21
Procurement (cid:129) 7–11, page 22
Chapter 8
Nutrition Care Management, page 22
Purpose and scope (cid:129) 8–1, page 22
Mission (cid:129) 8–2, page 22
Organization and functions (cid:129) 8–3, page 22
Responsibilities (cid:129) 8–4, page 22
Persons authorized to eat in the military treatment facility’s nutrition care division (cid:129) 8–5, page 23
Cash collections (cid:129) 8–6, page 23
Personnel management (cid:129) 8–7, page 23
Standard hospital diets (cid:129) 8–8, page 24
Clinical dietetics management (cid:129) 8–9, page 24
The military treatment facility menu (cid:129) 8–10, page 25
Subsistence and supply management (cid:129) 8–11, page 25
Food management (cid:129) 8–12, page 25
A la carte meal service (cid:129) 8–13, page 26
Ration accounting (cid:129) 8–14, page 26
Food cost management (cid:129) 8–15, page 27
The nutrition care division activities report (cid:129) 8–16, page 27
Nutrition care division contracts (cid:129) 8–17, page 27
Termination of military treatment facility nutrition care operations (cid:129) 8–18, page 27
Other food service support (cid:129) 8–19, page 27
Subsistence for ambulatory patients on observation or receiving care in the emergency department, speech pathology,
gastroenterology, or other special clinics (cid:129) 8–20, page 28
Food service support during mass casualty (cid:129) 8–21, page 28
Food service support for military training exercises (cid:129) 8–22, page 28
Chapter 9
The Army Organ Transplant and Organ/Tissue Donation Programs, page 28
The Army-Navy Organ Transplant Service (cid:129) 9–1, page 28
The Army Organ and Tissue Donation Program (cid:129) 9–2, page 29
Chapter 10
Orthopedic Footwear, page 32
Persons eligible for orthopedic footwear (cid:129) 10–1, page 32
Number of pairs of orthopedic footwear furnished (cid:129) 10–2, page 33
Types of orthopedic footwear available (cid:129) 10–3, page 33
Procedures for obtaining orthopedic footwear (cid:129) 10–4, page 33
Replacement orders (cid:129) 10–5, page 34
Delivering footwear after patient transfer (cid:129) 10–6, page 34
AR 40–3 (cid:129) 23 April 2013 iii
Contents—Continued
Orthopedic adjustments to standard footwear (cid:129) 10–7, page 35
Repairing orthopedic footwear (cid:129) 10–8, page 35
Orthopedic lasts and patterns (cid:129) 10–9, page 35
Moving active duty military members to the Department of Veterans Affairs Network Prosthetics Center (cid:129) 10–10,
page 35
Chapter 11
Pharmacy and Medication Management, page 35
Purpose and applicability (cid:129) 11–1, page 35
Responsibilities (cid:129) 11–2, page 35
Monetary collections for medicine (cid:129) 11–3, page 36
Personnel (cid:129) 11–4, page 36
Pharmacy benefits (cid:129) 11–5, page 37
Basic core formulary and committed use requirement contracts (cid:129) 11–6, page 37
Pharmacy and therapeutics committee (cid:129) 11–7, page 37
Therapeutic dietary supplements (cid:129) 11–8, page 38
Performance improvement (cid:129) 11–9, page 38
Controlled substances (cid:129) 11–10, page 39
Individuals authorized to write prescriptions (cid:129) 11–11, page 39
Signatures (cid:129) 11–12, page 40
Prescription writing (cid:129) 11–13, page 40
Dispensing (cid:129) 11–14, page 41
Mailing prescriptions (cid:129) 11–15, page 42
Prescription transfers (cid:129) 11–16, page 42
Labeling (cid:129) 11–17, page 43
Numbering and filing (cid:129) 11–18, page 43
Stock record (cid:129) 11–19, page 43
Disposition of drugs collected from patients (cid:129) 11–20, page 43
Pharmacy supply and support functions (cid:129) 11–21, page 43
Inspection and disposition of prescription files and records (cid:129) 11–22, page 44
Investigational drugs (cid:129) 11–23, page 44
Patient counseling (cid:129) 11–24, page 44
Drug samples (cid:129) 11–25, page 44
Pharmacy support to mobilizing and deploying personnel (cid:129) 11–26, page 44
Field pharmacy operational considerations (cid:129) 11–27, page 45
Pharmacy and medication automation (cid:129) 11–28, page 45
Chapter 12
Use and Control of Psychological Test Materials, page 46
Purpose and scope (cid:129) 12–1, page 46
Objective (cid:129) 12–2, page 46
Policy (cid:129) 12–3, page 46
Supplemental conditions of psychological test use (cid:129) 12–4, page 46
Qualifications of occupations and specialties in psychological testing (cid:129) 12–5, page 47
Chapter 13
Emergency Medical Services, page 48
Applicability (cid:129) 13–1, page 48
Scope (cid:129) 13–2, page 48
Policy (cid:129) 13–3, page 48
Chapter 14
Medical Laboratory Management, page 51
General (cid:129) 14–1, page 51
Applicability (cid:129) 14–2, page 51
iv AR 40–3 (cid:129) 23 April 2013
Contents—Continued
Responsibilities (cid:129) 14–3, page 51
Accreditation policies (cid:129) 14–4, page 53
Laboratory personnel (cid:129) 14–5, page 54
Quality control (cid:129) 14–6, page 54
Monetary collections for laboratory services (cid:129) 14–7, page 54
Improving organizational performance (cid:129) 14–8, page 54
Individuals authorized to order laboratory tests (cid:129) 14–9, page 55
Self-performance of laboratory tests (cid:129) 14–10, page 55
Inspection and disposition of laboratory files and records (cid:129) 14–11, page 55
Chapter 15
Veterinary Care, page 55
General (cid:129) 15–1, page 55
Veterinary services (cid:129) 15–2, page 56
Authorizing care (cid:129) 15–3, page 56
Providing veterinary medical care (cid:129) 15–4, page 56
Veterinary training assistance team (cid:129) 15–5, page 56
Chapter 16
Air Ambulance Vehicles, page 57
Purpose (cid:129) 16–1, page 57
General (cid:129) 16–2, page 57
Authorization (cid:129) 16–3, page 57
Operational control (cid:129) 16–4, page 57
Equipment (cid:129) 16–5, page 58
Chapter 17
Placement and Use of Automatic External Defibrillators on Army Installations and Within Army Facilities,
page 58
Overview (cid:129) 17–1, page 58
Authority and guidance (cid:129) 17–2, page 58
Responsibilities (cid:129) 17–3, page 58
Operational control (cid:129) 17–4, page 59
Procurement of automatic external defibrillators (cid:129) 17–5, page 60
Legal considerations for the use of automatic external defibrillators (cid:129) 17–6, page 60
Additional guidance (cid:129) 17–7, page 60
Chapter 18
Nursing Administrative Forms, page 60
Purpose (cid:129) 18–1, page 60
Form description and use (cid:129) 18–2, page 60
Appendixes
A. References, page 62
B. Inventory, Control, and Accountability of Controlled Substances, Select Noncontrolled Medications, and
Diagnostic Agents, page 70
C. Internal Control Evaluation Checklist, page 83
D. Essential Equipment on Aerial Ambulance, page 86
Table List
Table 8–1: Meal conversion factors (weights), page 26
Table 13–1: Chief, emergency medical services—experience, training, and certification requirements, page 49
AR 40–3 (cid:129) 23 April 2013 v
Contents—Continued
Table 13–2: Emergency medical services staff physicians—experience, training, and certification requirements,
page 49
Figure List
Figure B–1: Example of a completed DA Form 3949–1, page 72
Figure B–2: Example of a completed DA Form 3949, page 73
Figure B–3: Sample of a completed DA Form 1296, front, page 76
Figure B–4: Sample of a completed DA Form 1296, reverse, page 77
Figure B–5: Example of a completed DA Form 3862, front, page 79
Figure B–6: Example of a completed DA Form 3862, reverse, page 80
Glossary
vi AR 40–3 (cid:129) 23 April 2013