AF Form 3854: Receipt for Patient’s Valuables (Download PDF)

AF Form 3854: Receipt for Patient’s Valuables (Download PDF) – If you’re assigned to a U.S. Air Force medical treatment facility (MTF), aeromedical evacuation (AE) team, or supporting patient movement operations, AF Form 3854 is a critical document for securely handling and documenting a patient’s personal valuables. This form provides an official receipt that protects both the patient and the facility by creating a clear chain of custody for items like jewelry, wallets, cash, electronics, or other personal property during medical care or transport.

What Is AF Form 3854?

AF Form 3854, titled Receipt for Patient’s Valuables, is an official Department of the Air Force form used in military medical settings. It documents the transfer and safekeeping of a patient’s valuables when they are admitted to an MTF, placed in staging, or moved via aeromedical evacuation.

The form is particularly important for:

  • Unconscious or incompetent patients
  • Patients unable to retain possession of their items due to medical condition or procedure
  • Aeromedical evacuation scenarios where valuables must be transferred between facilities or personnel

It creates a written record that includes the patient’s identification, a detailed description of the items, and signatures from both the individual receiving the valuables and the patient (when able). This helps prevent loss, theft, or disputes over personal property.

Official Download Link (Current PDF):
Download AF Form 3854 PDF directly from the Air Force e-Publishing site.

Why AF Form 3854 Matters in Air Force Medicine?

Air Force medical operations follow strict protocols to protect patient property while delivering care. Valuables left unsecured can lead to administrative issues, security concerns, or liability. AF Form 3854 supports compliance with Department of the Air Force Instructions (DAFIs) governing aeromedical evacuation and medical care management.

It is explicitly referenced in DAFI 48-107V3 (Aeromedical Evacuation Documentation), which states that AF Form 3854 is utilized to transfer valuables of unconscious or incompetent patients between MTFs or staging facilities. It is often used alongside AF Form 1052 (Envelope/Record of Patient Storing Valuables).

In inpatient or same-day surgery settings, facilities may have local policies for collecting, storing, and documenting valuables in locked containers or safes, with the form serving as the primary receipt.

When to Use AF Form 3854?

Common scenarios include:

  • Hospital Admission — Patient arrives with valuables that cannot remain with them during treatment or surgery.
  • Aeromedical Evacuation (AE) — Transferring patients between facilities; valuables must be handed off securely.
  • Unconscious or Incapacitated Patients — Staff or escorts document and secure items on the patient’s behalf.
  • Staging Facilities — Temporary holding areas during patient movement.
  • Emergency or Inpatient Settings — Where policy requires securing high-value or sentimental items.

The form helps maintain accountability from the moment items are received until they are returned to the patient or authorized representative.

How to Fill Out AF Form 3854 (Step-by-Step Guidance)?

While the form itself is straightforward, accurate completion is essential for legal and administrative purposes. Typical fields include:

  1. Patient Information — Full name, rank/grade (if applicable), unit of assignment, and date of admission.
  2. Description of Valuables — Provide a detailed inventory (e.g., “Silver wedding band with engraving, black leather wallet containing $45 USD and ID cards, iPhone in black case”). Be as specific as possible, including quantity, make/model, serial numbers, and condition.
  3. Received By — Name, rank, and signature of the medical or support personnel taking custody.
  4. Patient or Representative — Signature of the patient (if competent) or authorized representative, along with date and time.
  5. Return Section — Often includes fields for when and to whom items were returned, with matching signatures.

Best Practices:

  • Inventory items in the presence of the patient or witness whenever possible.
  • Use clear, legible handwriting or electronic means if allowed by your facility.
  • Attach the form to the patient’s records or use it with a sealed envelope (e.g., AF Form 1052).
  • Follow your local MTF or AE unit’s standard operating procedures (SOPs) for storage and chain-of-custody.

Note: Always consult the latest version of the form and applicable DAFIs, as local supplements may apply. No separate detailed filling instructions are published centrally beyond the form’s layout and references in AE documentation.

  • AF Form 1052 — Envelope/Record of Patient Storing Valuables (often used together).
  • AF Form 3851 — Patient Baggage Data.
  • DAFI 48-107V1 & V3 — Key instructions covering patient movement documentation and aeromedical evacuation.
  • AFI 44-102 — Medical Care Management (broader context for patient rights and property handling).

All official Air Force forms and publications are available through the AF e-Publishing website.

Tips for Air Force Personnel and Medical Staff (USA)

  • Security First — Store valuables in designated facility safes or locked areas only.
  • Patient Communication — Explain the process clearly to reduce anxiety, especially for deployed or PCSing Airmen and their families.
  • Documentation — Errors or incomplete forms can complicate audits or patient complaints. Double-check descriptions and signatures.
  • Training — Medical technicians, nurses, and AE personnel should receive training on valuables handling as part of patient administration procedures.
  • Privacy Act Considerations — Handling patient information and property falls under DoD privacy and HIPAA-equivalent rules in military health settings.

For questions specific to your base or unit, contact your MTF Patient Administration section, Aeromedical Evacuation Squadron, or legal office.

Download AF Form 3854 Today

Ensure you have the most current version:
Download Official AF Form 3854 PDF

Bookmark the Air Force e-Publishing site for future updates to forms and instructions.

This guide is for informational purposes and is based on publicly available Department of the Air Force publications and forms as of 2026. Always verify the latest guidance through official channels (e-Publishing.af.mil) and follow your chain of command and local policies. This is not legal advice.

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By following proper procedures with AF Form 3854, Air Force medical teams uphold high standards of accountability, patient trust, and operational readiness.