DA Form 3761: Public Health Nursing Activities Report

DA Form 3761: Public Health Nursing Activities Report – DA Form 3761, officially titled the Public Health Nursing Activities Report, is a standardized U.S. Army form used by public health nurses and community health nursing sections to document and track nursing activities related to public health services.

This form supports data collection for workload management, program evaluation, and reporting under Army public health guidelines. It is referenced in DA Pam 40-11 (Army Public Health Program) and helps contribute to broader medical summary reports.

What Is DA Form 3761?

DA Form 3761 is a military form released by the Department of the Army on October 1, 2008 (with previous editions obsolete). It is used exclusively within the U.S. Army medical system, primarily by public health nurses in Medical Treatment Facilities (MTFs), MEDDACs, and MEDCENs.

The form captures visits, clinics/classes, caseloads, referrals, and miscellaneous activities across categories such as maternal and child health, disease control, health promotion, and more. It can be prepared as a daily, weekly, or monthly report (check the applicable box), with cumulative totals for analysis.

Official Download Link: DA Form 3761 PDF (from Army Publishing Directorate).

Purpose and Importance of the Public Health Nursing Activities Report

The primary purpose of DA Form 3761 is to report and quantify public health nursing activities to support planning, evaluation, and resource allocation in Army healthcare.

It provides data for:

  • Monitoring community health nursing services.
  • Contributing to higher-level reports like the Medical Summary Report.
  • Evaluating program effectiveness in areas like disease prevention, health promotion, and family support.
  • Ensuring compliance with Army Public Health Program requirements under AR 40-5 and DA Pam 40-11.

Accurate completion helps Army leadership understand workload, identify trends in beneficiary health needs (Soldiers, Families, retirees, and civilians), and improve readiness through preventive care.

Who Uses DA Form 3761?

  • Public health nurses and community health nursing sections in Army MTFs.
  • Preventive Medicine services.
  • Nurse practitioners or specialists involved in population-focused care.
  • Leadership for program oversight and reporting to higher commands (e.g., OTSG – Office of The Surgeon General).

It applies to the Active Army, Army National Guard, and Army Reserve components where relevant public health nursing services are provided.

Key Sections of DA Form 3761

Section A – Visits

This section tracks patient visits by:

  • Program Classification (e.g., Maternal and Child Health – Antepartum, Postpartum, Newborn; Child Abuse/Neglect; Health Promotion; Disease Control – TB, Venereal, Communicable, etc.).
  • Personnel Category (Active Duty, Retirees, Family Members, etc.).
  • Age Groups (0-12 months, 1-4 years, up to 65+).
  • Visit Location (Office, Home, Ward, Clinic).

Totals are cumulative.

Section B – Clinics, Classes

Records the number of clinics or classes held (e.g., Well Baby, Immunizations, Prenatal, Postpartum, Expectant Parent, Diabetic, TB) along with sessions, patient attendance, and family records.

Section C – Caseload

Tracks patient and family records:

  • Beginning total.
  • Opened and closed during the period.
  • Ending total.

Section D – Miscellaneous Activities

Includes:

  • Referrals (in/out).
  • Telephone visits.
  • Unable to locate visits.
  • Conferences on behalf of patients or programs.
  • Other program activities (administration, staff development, meetings – continued on reverse).

The form also requires the reporting installation and the name of the individual preparing the report.

How to Fill Out DA Form 3761?

  1. Header: Check DAILY, WEEKLY, or MONTHLY. Enter the date or period.
  2. Complete sections A–D with accurate counts. Use cumulative totals where indicated.
  3. Narrative: Often accompanied by a narrative report describing services (per historical guidance).
  4. Review and Sign: Ensure totals reconcile; the preparer signs.
  5. Distribution: Submit to the chief of preventive medicine at the MTF, with information copies as required (e.g., to nursing leadership or higher commands).

Tip: Maintain supporting records for audits. Electronic tools or fillable PDFs can streamline completion.

For the most current instructions, consult DA Pam 40-11 or your local preventive medicine/public health leadership, as specific procedures may align with the latest Army Public Health Program guidance.

Benefits of Proper Use

  • Supports data-driven decisions for health promotion and disease prevention.
  • Enhances Army readiness by tracking services that mitigate health risks.
  • Aids in compliance with federal, state, and local public health reporting where applicable.
  • Facilitates resource justification and program improvements.
  • DA Pam 40-11: Army Public Health Program – Primary reference.
  • Army Publishing Directorate for official forms.
  • Local Army Public Health Nursing or Preventive Medicine departments for training.

Download the Form Here: https://armypubs.army.mil/pub/eforms/DR_a/pdf/A3761.pdf

This guide is for informational purposes and targets U.S. Army medical personnel. Always refer to official Army publications and current command guidance for policy compliance. For questions, contact your installation’s Public Health Nursing section.