STITCH THROUGH THIS LINE IN BINDING 
T 1 ou m ZTSTo. 25 (Slxeei: 1). 
Separate Reports of Sick and Wounded for Regular and Volunteer Troops should be rendered. 
Page 1. 
t 
Here note matters of general interest in relation to the medical condition of the 
command, as prevailing diseases, their causation, measures adopted for their pre¬ 
vention, etc. Also matters relating to individual cases, such as notes of autopsies, 
etc. Reports of cases should not be entered here, but should be made separately. 
The notes called for in this column do not relieve a medical officer from the duty 
of reporting specially on any of the subjects indicated should their importance 
require a special record. Reports relating to commands in the field should show 
in these “Remarks” the locations of the principal camps occupied during the 
month with dates of arrival and of departure. 
REPORT OF SICK AND WOUNDED 
[Hero Rtato name of Regiment or Field Hospital (Post or Gcnoral Hospital) with location on last day.] 
Month of L 
190 
1 
(Give beginning and end of period if for less than a month.) 
This report is required monthly from every post, separate command, and general hospital; it should bo forwarded in 
duplicate, one copy to the Surgeon General direct, the other to the Chief Surgeon, before the fifth day of the next suc¬ 
ceeding month. In time of war only one copy of this report is required from general hospitals and from organizations 
and hospitals in the field. It should bo forwarded from general hospitals direct to the Surgeon General (unless other¬ 
wise ordered), and from organizations and hospitals in thr field to the Surgeon General through' the Chief Sfirgeon. 
When two or more sheets are required to perfect the tfyi.rt they should be stitched together through binding space 
before forwarding. When a hospital is closed or an organization is broken up, a report' covering tlio unreported period 
of service, giving the beginning and eifli thereof, should in yike manner bo forwarded within five days after tho break¬ 
ing up of the organization. (See pars. 170 and 171, Manual for tho Medical Department, 1900.) 
COMMAND. 
Here specify the command and the companies and detachments composing it on the last day, together with the 
brigade, division, and army, or department in which it is serving. Important variations from the general composition 
of the command, as the arrival or departure of companies, should be stated under “Remarks, on tho left, giving the 
date and the names of accompanying medical officers. 
IRIEIMZ-ATEIIKIS- 
Here noto the prevalence and character of diseases affecting the civilian attaches 
of tho command, the extent of their prevalence, their probable causes, and pre¬ 
disposing conditions. The civilian attaches include the wives and children, rela¬ 
tives and servants of officers and enlisted men, as well as all other civilians, male 
and female, connected with the command or permitted to live at the post, in¬ 
cluding departmental employees, retired and discharged soldiers, and military 
prisoners, who, by the terms of their sentence or otherwise, have been discharged 
from tho service of the United States; but the employees of contractors engaged 
temporarily in building or other work are not to be considered as attaches of the 
command. In addition to general remarks there may also be entered in this 
column short notes on points conneptejl with the history of individual cases, 
memoranda of postf-mc^m examinations, etc., but special reports of unusual or 
interesting cases should be rendered separately. (Par. 176, Manual for the 
Medical Department, 1900.) 
_; children,- 
Adult males, _ 
iTflidult females,. 
Here note also the data required by paragraph 138, Manual for the Medical 
Department, 1900. 
(If nothing calling for report or comment has occurred during the month, the 
fact should be stated.) 
Mean strength during month obtained from the Adjutant of tho command, averaged for 
Officers-- 
. days: 
Enlisted men. 
White 1 
Colored 
Indian _ 
Total. 
Indian scouts. 
NUMERICAL REPORT FOR THE MONTH. 
Report of — 
| 
a 
o . 
bfifl 
a o 
a s 
"a 
a 
<D 
Admissions. 
Total to be accounted 
for. 
From command. 
From other 
Sources. 
Returned toduty. 
•0 
O 
P 
Discharged for 
disability. 
By transfer. 
s 
1 
£ 
© 
Officers and en- 
General 
Completed Cases. 
Hos. Qrs. 
Aggregate Number 
of 1)ays Lost from 
Sickness. 
Not 
used. 
Not 
used. 
Not 
used. 
Not 
used. 
‘Remaining on sick report” in “Quarters,” and tho time for 
Cases of officers and soldiers absent sick at the end of tho month will bo carried on this summary ns • 
such cases will lie entered under tho “Aggregate number of days lost from sickness” w “Absent.” 
Deaths, etc., occurring a... those nut on u,:k r a ,ort. will bo tabulated in rod ink above the lino and iufiULWW^^a**. 
Civilians (including ox-ofliccre and ex-soldiers) and general Prisouers will be reported in this summary only when they receive hospital treatment or die. 
NOTES. 
• 
Enter in tho proper columns on the other side of this sheet, and on similarly ruled sheets, if required, full transcripts from tho Register of Patients of all cases 
treated durimr the month including those “remaining" as well as all deaths and discharges occurring not on sick report during the period, the names to he 
arranged in the senuenco of the Register numbers. The day, only, is required to be entered in Column XVI for cases completed during tho month. Cases remain¬ 
ing on sick report nt the end of tho month will have in their respective columns the register number, liamo, rank, company, and regiment or corps, the date of 
admissionami'its source if from other hospitals with its cause so far as determined at the time, and will have the word “ Remaining ” written or stamped in Column 
XV T„ the renort for the month of December, Columns VI, VII, VIII, and IX should also he filled in and the place of treatment given III Column XII; nltemtionsor 
‘ remaining at the end of each.nth do not relieve the medical officer from reporting fully on tho completed ease, including such changes. 
ftm Entries fihould be plainly and carefully written with a moderately coarse peu and permanent black Ink. Corrections should he authenticated by the initials of tho 
CTeld Register is Improvised from these sheets, see paragraph 101, Manual for tho Medical Department WOO, its preparation will be governed by tho 
1 t-lver, for flllliig the various col.ns of the Register of Patients. The data called for in Columns VI, VII, VIII, and IX will he filled in in all cases except 
the Information can not he readily obtained or when exigencies of service prevent compliance with pars. 149 to 102, and 178, Manual lor tho Medical 
Department, 1900. 
I CERTIFY that this report covers . 
..pages, and contains accurate details of . ... . completed cases. 
The officer rendering this report will sign this certificate and will close the list of entries on the last page by his official signature. 
In the absence of a medical officer tho physician rendering professional service should sign tho Iteport of Sick and Wounded, (l’ar. 13S, Manual for tho Medical Department, 1900.) 
Surgeon, U. S. Army. 
DO NOT WRITE ON THE MARGINS OR BINDING SPACE. 
