DA Form 4160: Patient’s Personal Effects Record (PDF) – DA Form 4160, titled Patient’s Personal Effects and Clothing Record, is a U.S. Army form used in military medical treatment facilities (MTFs). It documents and inventories a patient’s personal belongings and clothing upon admission, during their stay, and at discharge.
Released on October 1, 1973, by the Department of the Army, the form remains active for use under AR 40-400 (Patient Administration). It ensures accountability, security, and proper return of personal items, reducing loss or disputes in hospital settings.
Download the Official DA Form 4160 PDF Here:
Download DA Form 4160
Purpose of the Patient’s Personal Effects and Clothing Record
The primary purpose of DA Form 4160 is to create an official inventory of a patient’s clothing and personal effects. This protects both the patient and the medical facility by providing a clear record of items received, stored, or issued during hospitalization.
Key benefits include:
- Preventing loss or theft of personal items.
- Documenting hospital-issued items (e.g., pajamas, robes, towels).
- Supporting accountability for high-value or sentimental belongings.
- Facilitating smooth discharge processes.
It is especially important for active-duty service members, where uniform items and personal gear must be tracked precisely.
Who Uses DA Form 4160?
This form is primarily used by:
- Army medical personnel and custodians in military hospitals.
- Patients (active duty, retirees, or authorized civilians in Army MTFs).
- Unit representatives or next of kin in certain cases.
It applies across U.S. Army medical facilities worldwide and supports compliance with patient administration regulations.
How to Fill Out DA Form 4160 Step-by-Step?
Filling out the form requires accuracy and signatures from both the patient and custodian. Here’s a general guide based on the form structure:
- Patient Identification: Enter the patient’s full name (last, first, middle initial), grade/rank, Social Security Number, and medical facility register number.
- Inventory Sections: The form lists numerous clothing and effects items with quantity columns. Common categories include:
- Uniform items (blouse, trousers, boots, caps, etc.).
- Personal clothing (shirts, underwear, socks, shoes).
- Accessories (belts, gloves, insignia).
- Hospital-issued items (pajamas, robe, slippers, towels).
- Quantities and Dates: Record quantities in the appropriate columns. Use dated columns for admissions, transfers, or discharges.
- Signatures: Both the patient and custodian must initial or sign in designated areas to verify the inventory. A final statement confirms all listed items have been received or accounted for.
Tip: Use the fillable PDF version for digital completion where allowed. Always keep copies for records.
Key Sections on the DA Form 4160
The form is divided into clear tables for male and female items, plus hospital-issued goods. It covers everything from combat boots and utility jackets to civilian clothing like suits or dresses. Additional “Other” fields allow for unique items.
Hospital items section specifically tracks robes, pajamas, towels, and similar temporary issuances.
Importance in Army Medical Facilities
Proper use of DA Form 4160 supports broader patient administration policies outlined in AR 40-400. It helps maintain order in busy medical environments and ensures service members’ gear is secure, especially during extended hospital stays or medical evacuations.
For deployed or training scenarios, accurate personal effects tracking can be critical for continuity of care and equipment accountability.
Where to Download and Access DA Form 4160?
The official, current version is available directly from the U.S. Army Publishing Directorate:
Official Download: DA Form 4160 PDF
Additional resources:
- Army Publishing Directorate (armypubs.army.mil)
- Your local military treatment facility’s patient administration office
Note: This form is produced in electronic media and includes a Privacy Act statement per AR 340-21.
Frequently Asked Questions (FAQs)
Is DA Form 4160 the same as a DD Form?
No. It is a Department of the Army (DA) form, not a Defense Department (DD) form.
Do I need this form for outpatient visits?
It is primarily for inpatients or those whose personal effects are stored by the facility.
Can it be completed digitally?
Yes, fillable versions are widely available, and digital signatures are often accepted.
What if items are missing?
Discrepancies should be noted immediately and investigated per facility policy.
For the most current guidance, consult your local Army medical command or AR 40-400.
This guide is for informational purposes. Always refer to official Army regulations and your chain of command for procedural requirements.