DA Form 3365: Medical Warning Tag Authorization (PDF) – DA Form 3365, officially titled Authorization for Medical Warning Tag, is a critical U.S. Army document used to authorize the issuance of a red medical warning tag (often worn with standard dog tags). This form ensures that emergency medical personnel can quickly identify serious, permanent health conditions when a service member cannot communicate their medical history.
What Is DA Form 3365?
DA Form 3365 is the official form for requesting and authorizing a Medical Warning Tag for eligible Army personnel, beneficiaries, and other authorized individuals. It is governed by AR 40-66 (Medical Record Administration and Healthcare Documentation), with the Office of The Surgeon General as the proponent agency.
The form facilitates the creation of a bright red aluminum tag (similar in size and shape to standard ID tags) that lists critical medical information. It is typically embossed using the same machines that produce regular dog tags. A corresponding DA Label 162 (Emergency Medical Identification Symbol, featuring the Star of Life) is affixed to the individual’s health record for quick reference.
Download the official DA Form 3365 PDF here: https://armypubs.army.mil/pub/eforms/DR_a/pdf/A3365.pdf
Purpose of the Medical Warning Tag and DA Form 3365
The primary purpose is patient safety in emergencies. The tag provides rapid recognition of selected health problems when medical records are unavailable and the individual cannot provide a history (e.g., unconsciousness).
It alerts providers to conditions where improper treatment could be life-threatening, such as administering penicillin to someone with a severe allergy. The form documents the authorization, ensures proper embossing of tag content, and tracks delivery to the patient.
Who Needs a Medical Warning Tag?
Medical officers (including dental officers) determine eligibility based on specific criteria in AR 40-66. Conditions should be:
- Permanent or long-term in nature.
- Well-established with a definite diagnosis.
- Such that lack of knowledge could compromise emergency care.
Common qualifying conditions include:
- Severe allergies (e.g., to penicillin, other antibiotics, or drugs).
- Sensitivities to biological products or immunizing agents.
- Convulsive disorders (epilepsy).
- Diabetes mellitus.
- Adrenal insufficiency.
- Special medication requirements (e.g., anticoagulants, anticonvulsants, corticosteroids).
- Sensitivity to insect stings.
- Sickle cell disease.
- Wearing contact lenses (in some cases).
The tag is not for temporary conditions and must be medically justified.
How to Fill Out DA Form 3365: Step-by-Step?
- Patient Identification: Enter the patient’s full name (last, first, middle), grade/status, identification number (e.g., SSN or DoD ID), organization/unit (for military personnel), home address, and phone numbers.
- From/To Sections: Specify the originating Medical Treatment Facility (clinic, ward, etc.) and the recipient (embossing unit or relevant party).
- Tag Content: This is the core section. Fill in up to 5 lines of embossed information in the designated format (e.g., name, ID, blood type, allergies, medical conditions). Use clear, concise language.
- Medical Officer Authorization: The requesting medical or dental officer types their name and signs, with the date.
- Delivery Confirmation: A responsible officer signs to confirm delivery to the patient (or notes a person to call if different from the patient), with the date delivered.
Tips: Prepare in original plus copies. One copy stays in the health record. Accuracy is essential, as the tag is embossed directly from this data. Consult your medical treatment facility for local procedures.
Step-by-Step Process for Issuance
- A medical officer identifies the need during care or periodic exams.
- The officer completes and signs DA Form 3365.
- The form is forwarded to an authorized embossing unit.
- The red tag is prepared and delivered to the patient.
- DA Label 162 is affixed to the health record.
- The patient is counseled on the importance of wearing the tag at all times and provided with instructions.
Commanders and medical personnel have specific responsibilities for training, supply, and enforcement.
Importance for Soldier Readiness and Safety
Medical warning tags directly support Individual Medical Readiness (IMR) and deployment preparedness. They are part of ensuring service members have necessary individual medical equipment. Failure to wear or maintain the tag when required can impact readiness status.
In combat or emergency situations, the bright red tag provides life-saving information faster than accessing electronic records.
Where to Get DA Form 3365 and the Medical Warning Tag?
- Official Download: Army Publishing Directorate – DA Form 3365 PDF.
- Through your local Military Treatment Facility (MTF), clinic, or embossing unit.
- Tag blanks are requisitioned through normal supply channels (historically FSN 6530-142-8775 for metal blanks).
Service members should contact their unit medical personnel or patient administration for assistance.
Frequently Asked Questions (FAQs)
Is DA Form 3365 still current?
Yes, it remains the authorized form under AR 40-66.
Do I have to wear the red tag?
Yes, when issued, individuals are responsible for wearing it at all times for protection, similar to standard dog tags.
Can family members or civilians get one?
Eligible beneficiaries receiving care at Army MTFs may qualify per AR 40-66 criteria.
What if my condition changes?
A new form should be processed to update or cancel the tag as needed.
For the most current guidance, refer to AR 40-66 or consult your Army medical provider. This form and the associated tag program remain vital tools for protecting service members’ health in the U.S. Army. Always verify procedures with official sources or your chain of command.