DAFORMFILLABLE.COM | DA FORM 4159 Fillable – Army Pubs 4159 PDF – DA FORM 4159 is a critical document utilized by individuals seeking medical care in a federal medical treatment facility that is outside the Department of Defense (DoD). This form, established on May 1, 2009, plays an essential role in ensuring that medical care requests are processed efficiently and in compliance with regulatory requirements.
DA FORM 4159 – Request For Medical Care In A Federal Medical Treatment Facility Outside Department Of Defense
| Form Number | DA Form 4159 |
| Form Title | Request For Medical Care In A Federal Medical Treatment Facility Outside Department Of Defense |
| Form Date | 05/01/2009 |
| Form Proponent | TSG |
What is DA FORM 4159?
DA FORM 4159, also known as the Request For Medical Care In A Federal Medical Treatment Facility Outside Department Of Defense, is a formal document used to facilitate medical care for eligible individuals in federal facilities outside the DoD. This form is crucial for service members, retirees, and their dependents who need medical services not available within the DoD facilities.
Key Details of DA FORM 4159
- Pub/Form Number: DA FORM 4159
- Pub/Form Date: 05/01/2009
- Pub/Form Title: REQUEST FOR MEDICAL CARE IN A FEDERAL MEDICAL TREATMENT FACILITY OUTSIDE DEPARTMENT OF DEFENSE
- Pub/Form Proponent: The Surgeon General (TSG)
- Pub/Form Status: ACTIVE
- Prescribed Forms/Prescribing Directive: AR 40-400
- Footnotes:
- 42-ITEM ONLY PRODUCED IN ELECTRONIC MEDIA
- 14-REQUIRES PRIVACY ACT STATEMENT (AR 340-21)
- Security Classification: UNCLASSIFIED
- Distribution Restriction Code: A (APPROVED FOR PUBLIC RELEASE; DISTRIBUTION IS UNLIMITED)
Purpose of DA FORM 4159
The primary purpose of DA FORM 4159 is to authorize and document the provision of medical care in federal treatment facilities outside the DoD. This form ensures that the medical care provided is appropriately requested, authorized, and recorded, adhering to the standards and regulations set by the Army.
Filling Out DA FORM 4159
To correctly complete DA FORM 4159, individuals must provide comprehensive and accurate information. This includes:
- Personal Details: Full name, rank, social security number, and contact information.
- Medical Information: Detailed description of the medical condition and the type of care required.
- Facility Information: Name and address of the federal medical treatment facility where care is requested.
- Authorization: Signatures from the appropriate medical and administrative personnel to approve the request.
Importance of Privacy and Compliance
DA FORM 4159 requires a Privacy Act Statement as mandated by AR 340-21. This ensures that the personal and medical information provided is protected and used solely for the purpose of obtaining necessary medical care. Compliance with the Privacy Act is critical to safeguarding the privacy and rights of individuals.
Distribution and Accessibility
The form is classified as UNCLASSIFIED and has a distribution restriction code of A, indicating that it is approved for public release and distribution is unlimited. This means that eligible individuals can access and utilize the form without restrictions.
How DA FORM 4159 Supports Medical Care Outside the DoD
By using DA FORM 4159, individuals can seamlessly request and receive medical care from federal facilities outside the DoD, ensuring continuity of care when specific services are not available within DoD facilities. This form bridges the gap, allowing for a broader range of medical treatment options and facilitating better health outcomes for service members and their families.
Conclusion
DA FORM 4159 – Request For Medical Care In A Federal Medical Treatment Facility Outside Department Of Defense is a vital tool in the provision of medical care for eligible individuals outside the DoD. By understanding its purpose, requirements, and the proper way to complete it, service members and their families can ensure they receive the necessary medical attention in federal facilities, maintaining their health and well-being.
For more detailed information on filling out and submitting DA FORM 4159, refer to AR 40-400 and consult with your medical administrative office.
DA FORM 4159 Fillable – Army Pubs 4159 PDF DOWNLOAD
