DA Form 3705 PDF: Outpatient Treatment Records Download – DA Form 3705, titled Receipt for Outpatient Treatment/Dental Records, is an official U.S. Army form used to document the release and acknowledgment of outpatient medical or dental records. It serves as a formal receipt when patients (or their authorized representatives) take possession of their records from a military medical treatment facility (MTF).
The form is governed by AR 40-66 (Medical Record Administration and Health Care Documentation), with the Office of The Surgeon General as the proponent agency. The current edition dates to January 1980, and earlier versions remain acceptable until supplies are exhausted.
Download the official DA Form 3705 here: https://armypubs.army.mil/pub/eforms/DR_a/pdf/A3705.pdf
Purpose of DA Form 3705
The primary purpose of DA Form 3705 is to create an auditable record of when and to whom outpatient treatment records or dental records are released. Key elements include:
- Confirming the patient (or sponsor/guardian) received the records.
- Notifying the individual that lost or misplaced records cannot be duplicated by the military.
- Providing a delivery address or forwarding instructions for the records.
- Supporting proper medical record administration, continuity of care, and compliance with Army regulations.
This form helps maintain accountability for sensitive health information in both military and dependent outpatient settings.
Who Uses DA Form 3705?
DA Form 3705 is primarily used by:
- Active-duty service members receiving outpatient care.
- Military dependents and family members.
- Parents or legal guardians signing for minor children.
- Retirees or other eligible beneficiaries accessing records from Army medical facilities.
It applies in scenarios such as permanent change of station (PCS) moves, civilian provider referrals, or when patients need temporary possession of their outpatient treatment record (OTR) or dental records.
How to Fill Out DA Form 3705 (Step-by-Step)?
Filling out the form is straightforward. Here are the main sections based on the official PDF:
- Name of Sponsor and SSN of Sponsor — Enter the sponsor’s full name and Social Security Number.
- Name(s) of Outpatient — List the patient(s) whose records are being released.
- New Unit of Assignment and Address of Sponsor (if applicable) — Provide current or upcoming assignment details.
- Treatment Period Covered by Record — Indicate the dates (first and last) for medical and/or dental entries.
- Acknowledgment Statement — The recipient reads and agrees to the terms (records cannot be duplicated if lost).
- Delivery Address — Print the name and address of the medical facility or doctor receiving the records.
- Printed Name and Relationship (if signing for someone else).
- Signature and Date — The patient or authorized representative signs and dates the form.
For minors, a parent or legal guardian must sign. Always complete the address block at the time of signing. The completed form is typically filed alphabetically at the medical records branch.
Tip: Use the official fillable or printable PDF from Army Publishing Directorate for best results.
When Is DA Form 3705 Required?
You will typically encounter DA Form 3705 when:
- Transferring outpatient records between military treatment facilities.
- Releasing records for civilian dental or medical care.
- Checking out records temporarily for personal use or second opinions.
- Processing requests for record transfer during PCS moves (often alongside DD Form 2138).
It ensures a clear chain of custody for health records, which is critical for ongoing care and administrative purposes.
Important Notes and Best Practices
- No Duplicates Policy — The form explicitly states that duplicate records will not be provided if the originals are lost. Safeguard them carefully.
- Privacy and Compliance — Handling follows HIPAA-equivalent standards and AR 40-66 guidelines for protected health information.
- Electronic Records Transition — While paper forms like DA Form 3705 remain in use, many records are now managed electronically through systems like AHLTA. Always check with your local MTF for current procedures.
- Where to Get Help — Contact your installation’s Outpatient Medical Records Branch or Patient Administration Division for assistance.
Download Official DA Form 3705
Access the most current and authorized version directly from the U.S. Army Publishing Directorate:
This is the trusted source for all official Army forms.
Conclusion
DA Form 3705 plays a vital role in U.S. Army healthcare administration by ensuring accountability for outpatient treatment and dental records. Whether you are a service member, dependent, or administrator, understanding and properly completing this form supports seamless continuity of care and regulatory compliance.
For the latest guidance, refer to AR 40-66 or consult your local military treatment facility. Always use the official form from armypubs.army.mil to avoid issues with outdated or unofficial versions.