Patient Administration - Army Publishing Directorate - U.S. Army

DA Form 3981
Transfer of Patient (Prescribed in para 2–13.)
DA Form 3983 (obsolete)
Patients’ Trust Fund Authorization for Deposit or Withdrawal of Funds and Valuables (Prescribed in para 12–7.)
DA Form 4029
Patient’s Clearance Record (Prescribed in para 4-6c.)
DA Form 4128
Patient’s Trust Fund Journal (Prescribed in paras 12–4, 12–5h, 12–7.)
DA Form 4159
Request for Medical Care in a Federal Medical Treatment Facility Outside Department of Defense (Prescribed in paras
9–5, 9–7.)
DA Form 4160
Patient’s Personal Effects and Clothing Record (Prescribed in paras 4–4, 4–5.)
DA Form 4665
Patients’ Trust Fund-Daily Summary Record (Prescribed in para 12–7.)
DA Form 4707
Entrance Physical Standards Board (EPSBD) Proceedings (Prescribed in paras 7–12a, 7–12c(4), 7–12d(5), 7–12d(7),
7–12d8), 7–12g.)
DD Form 7
Report of Treatment Furnished Pay Patients: Hospitalization Furnished (Part A) (Prescribed in paras 3-21b(3), 3-
24b(3)(c), 3-24c, 3-25a(2), 3-25a(3), 3-30a, 3-30b, 3-31b, 3-33e, 3-34, 3-38c, 3-41c, 3-41c, 3-47b, 11-9.)
DD Form 7A
Report of Treatment Furnished Pay Patients: Outpatient Treatment Furnished (Part B) (Prescribed in paras 3-23a(4), 3-
24b(1)(a), 3-24b(3)(c), 3-24c, 3-25a(2), 3-25a(3), 3-30a, 3-30b, 3-31a, 3-31b, 3-32c, 3-33e, 3-34, 3-38c, 3-41c, 3-47b,
11-9.)
DD Form 599
Patient’s Effect Storage Tag (Prescribed in para 4–5.)
DD Form 675
Receipt for Records and Patients Property (Prescribed in para 5-18a(6)(a).)
Section IV
Referenced Forms
Standard Forms (SF) can be downloaded at the GSA Forms Web site, http://www.gsa.gov/portal/forms/type/SF.
DA Form 2–1
Personnel Qualification Record-Part II
DA Form 11–2–R
Management Control Evaluation Certification Statement
DA Form 2173
Statement of Medical Examination and Duty Status
DA Form 3349
Physical Profile
DA Form 4359
Authorization for Psychiatric Service Treatment
98 AR 40–400 27 January 2010/RAR 15 September 2011