DAFORMFILLABLE.COM | DA FORM 5009 Fillable – Army Pubs 5009 PDF – DA FORM 5009, titled Medical Record – Release Against Medical Advice, is a crucial document in the medical field, particularly within the military healthcare system. This form is used when a patient chooses to leave a medical facility against the advice of their healthcare provider.
DA FORM 5009 – Medical Record – Release Against Medical Advice
| Form Number | DA Form 5009 |
| Form Title | Medical Record – Release Against Medical Advice |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Overview of DA FORM 5009
Pub/Form Number and Date
DA FORM 5009 was published on February 1, 2004. It is an active form, indicating its current use within the medical records management system of the United States Army.
Purpose and Usage
The primary purpose of DA FORM 5009 is to document instances where patients decide to release themselves from medical care against medical advice (AMA). This form serves as an official record to protect both the patient and the healthcare provider by clearly stating that the patient is leaving against the recommendations given by medical professionals.
Key Details of DA FORM 5009
Form Title and Proponent
The full title of the form is Medical Record – Release Against Medical Advice. The proponent for this form is TSG, which refers to The Surgeon General of the United States Army.
Form Status and Prescribing Directive
The status of DA FORM 5009 is active, meaning it is currently in use and relevant. It is prescribed by AR 40-68, the Army Regulation that governs medical services and healthcare delivery in the Army.
Privacy and Security
The form requires a Privacy Act Statement as per AR 340-21 to ensure that the patient’s privacy is protected. This statement informs the patient about how their personal information will be used and safeguarded.
Distribution and Accessibility
Distribution Code and Classification
The distribution restriction code for DA FORM 5009 is A, which means it is approved for public release and its distribution is unlimited. The security classification of the form is unclassified, making it accessible for public viewing and use.
Production and Format
DA FORM 5009 is produced only in electronic media, denoted by footnote 42. This format ensures that the form is readily available and can be easily distributed and accessed electronically.
Importance of DA FORM 5009 in Medical Records
Legal Protection
The form provides legal protection for healthcare providers by clearly documenting that the patient was informed about the potential risks of leaving against medical advice. It serves as evidence that the patient made an informed decision to leave, despite the medical recommendations given.
Patient Awareness
By signing DA FORM 5009, patients acknowledge that they have been advised of the risks and potential consequences of their decision to leave the medical facility. This ensures that patients are fully aware of their actions and the implications for their health.
Accountability
DA FORM 5009 helps maintain accountability within the medical system. It records the details of the patient’s decision, the advice provided by the healthcare professionals, and the patient’s understanding and acceptance of the associated risks.
How to Access and Use DA FORM 5009
Accessing the Form
Since DA FORM 5009 is produced in electronic media, it can be accessed through military medical record systems or specific Army databases. It is important for healthcare providers to ensure they use the most current version of the form.
Completing the Form
When completing DA FORM 5009, it is essential to include detailed information about the patient’s decision to leave against medical advice. This includes documenting the medical advice given, the patient’s reason for leaving, and any discussions regarding the risks involved.
Submission and Storage
Once completed, the form should be properly submitted and stored in the patient’s medical record. This ensures that there is a comprehensive and accessible record of the patient’s decision and the circumstances surrounding it.
Conclusion
DA FORM 5009 – Medical Record – Release Against Medical Advice plays a vital role in the healthcare system by ensuring that patients’ decisions to leave medical facilities against advice are well-documented and legally protected. Understanding and correctly utilizing this form is crucial for healthcare providers to maintain accurate medical records and uphold patient accountability.
By following the guidelines and ensuring proper documentation, medical professionals can safeguard both the patient’s health and the integrity of the medical care provided.
DA FORM 5009 Fillable – Army Pubs 5009 PDF DOWNLOAD
