DA Form 4700: Download Supplemental Medical Data PDF – U.S. Army form used to document additional healthcare information that does not fit on standard medical record forms.
It supplements primary records like SF 600 (Chronological Record of Medical Care) and supports comprehensive medical documentation for service members. Healthcare providers use it for various purposes, including examinations, diagnostic studies, treatments, and specialized reports.
What Is DA Form 4700?
DA Form 4700, titled Medical Record – Supplemental Medical Data, provides extra space and structure for detailed medical entries in Army medical records. The current version dates to February 2003 (with possible overprints and updates for specific uses).
Per AR 40-66 (Medical Record Administration and Healthcare Documentation), it serves as a flexible tool for information that standard forms cannot accommodate. Medical treatment facilities (MTFs) commonly use it for:
- Overprinted local forms (e.g., consent documents, eligibility reviews, questionnaires).
- Flow charts, detailed examination notes, or diagnostic summaries.
- Supplemental data like occupational health exposure records or special evaluations.
Note: A separate or adapted version of DA Form 4700 also functions as the Evacuation Patient Care Record (PCR) for documenting en route care during MEDEVAC/CASEVAC, but the primary supplemental use remains general medical records.
Purpose and Uses of DA Form 4700
The form supports accurate, complete medical documentation critical for continuity of care, deployments, PCS moves, and administrative needs. Common applications include:
- History and Physical (H&P) notes or additional evaluations.
- Diagnostic studies results summaries.
- Treatment details and flow charts.
- Specialized overprints, such as respite care eligibility for the Exceptional Family Member Program (EFMP), telehealth consents, MRI safety questionnaires, or advance directives.
- Occupational health records, including exposure monitoring.
Providers reference it on SF 600 when used. It ensures compliance with privacy rules (e.g., HIPAA, Privacy Act of 1974) and supports high-quality patient care in military settings.
How to Fill Out DA Form 4700?
Follow these general steps based on official guidelines:
- Report Title — Enter a clear title describing the content (e.g., “MRI Safety Questionnaire” or “Physical Therapy Evaluation”).
- OTSG Approval Date — Use YYYYMMDD format if applicable.
- Main Body — Record the detailed medical information. Use additional pages or the reverse side if needed.
- Prepared By — Include signature, title, department/service/clinic, and date (YYYYMMDD).
- Patient Identification — Provide full name (last, first, middle), grade/rank, SSN or DoD ID if required, and facility details.
- Purpose Checkbox — Select the appropriate category: History/Physical, Flow Chart, Other Examination/Evaluation, Diagnostic Studies, Treatment, or Other (specify).
Always ensure entries are legible, accurate, and authenticated. For electronic or overprinted versions, follow MTF policies and AR 40-66.
Pro Tip: When space is limited or for specific programs (e.g., EFMP respite care), use approved MEDCOM overprints on the DA Form 4700 template.
Where to Download DA Form 4700 PDF?
U.S. Army personnel and authorized users can download the official fillable PDF here:
Download DA Form 4700 PDF
Additional sources include the Army Publishing Directorate (APD) website and authorized MTF portals. Always use the most current version and any required overprints for your specific medical facility.
Filing and Record-Keeping Requirements
Per AR 40-66, file DA Form 4700 appropriately in the patient’s medical record (e.g., with related SF or DD forms). Electronic versions must meet standards for authenticity and retrievability. MTFs maintain records for active duty, reserves, and other eligible beneficiaries, with long-term retention for occupational health or deployment-related entries.
Proper use supports seamless care transitions, medical readiness, and compliance during audits or inspections.
Importance for Army Medical Readiness
Accurate supplemental documentation on DA Form 4700 helps ensure service members receive appropriate care, supports EFMP families, aids in aeromedical evacuation records, and maintains complete health histories essential for deployments and retention. It is a foundational tool in military healthcare administration.
For the latest guidance, consult your local MTF, AR 40-66, or the Office of the Surgeon General. Policies and overprints may evolve, so verify with official Army sources.