DAFORMFILLABLE.COM | DA FORM 5195 Fillable – Army Pubs 5195 PDF – DA FORM 5195 – Health Data is an essential document used by the Department of the Army to collect and manage health information. This form plays a critical role in maintaining accurate health records for military personnel, ensuring that all relevant health data is properly recorded and accessible.
DA FORM 5195 – Health Data
| Form Number | DA Form 5195 |
| Form Title | Health Data |
| Form Date | 10/01/2003 |
| Form Proponent | G-9 |
Publication Details
- Pub/Form Number: DA FORM 5195
- Pub/Form Date: 10/01/2003
- Pub/Form Title: HEALTH DATA
- Pub/Form Proponent: G-9
- Pub/Form Status: ACTIVE
- Prescribed Forms/Prescribing Directive: AR 608-18
- Footnotes:
- 14: REQUIRES PRIVACY ACT STATEMENT (AR 340-21)
- 42: ITEM ONLY PRODUCED IN ELECTRONIC MEDIA
- Security Classification: UNCLASSIFIED
- Distribution Restriction Code: A APPROVED FOR PUBLIC RELEASE; DISTRIBUTION IS UNLIMITED
- Pub/Form IDN: 990001
- Pub/Form PIN: 053285
Purpose and Importance of DA FORM 5195
DA FORM 5195 is designed to capture comprehensive health information about military personnel. This form ensures that health data is systematically documented, providing a reliable resource for medical professionals and administrative staff.
Key Objectives
- Accurate Health Records: To maintain up-to-date health records for all service members.
- Medical Readiness: To assess and ensure the medical readiness of military personnel.
- Data Accessibility: To provide easy access to health data for authorized personnel.
Structure of DA FORM 5195
Sections of the Form
- Personal Information: Includes basic details such as name, rank, and identification number.
- Health History: Documents the individual’s medical history, including past illnesses, surgeries, and chronic conditions.
- Current Health Status: Captures current health metrics and any ongoing treatments or medications.
- Allergies and Sensitivities: Lists any known allergies or sensitivities to medications or substances.
- Immunization Records: Provides a detailed record of immunizations received.
- Medical Examination Results: Includes findings from recent medical examinations and tests.
Privacy and Security
Given the sensitive nature of the information, DA FORM 5195 requires compliance with the Privacy Act Statement (AR 340-21). This ensures that all data is handled with the utmost confidentiality and only accessed by authorized individuals.
Utilizing DA FORM 5195
Who Should Use This Form?
- Medical Personnel: To document and review the health status of military members.
- Administrative Staff: To ensure that all health data is accurately recorded and filed.
- Military Commanders: To assess the overall health and readiness of their units.
Submission and Storage
Since DA FORM 5195 is produced in electronic media only, it must be filled out and submitted through the appropriate digital channels. This method enhances the efficiency and accuracy of data entry and reduces the risk of lost or damaged paper forms.
Compliance and Directives
The use of DA FORM 5195 is governed by AR 608-18, which outlines the procedures and requirements for documenting health data within the Army. Adhering to these directives ensures that all health information is collected consistently and complies with military standards.
Distribution and Access
This form is approved for public release and has an unlimited distribution restriction code. This means that while the form itself is accessible, the information within it is protected and only available to those with the necessary clearance.
Conclusion
DA FORM 5195 – Health Data is a crucial tool for managing the health information of military personnel. By ensuring accurate and comprehensive health records, this form supports the overall medical readiness and well-being of the Army’s members. Proper utilization and compliance with the prescribed directives are essential for maintaining the integrity and confidentiality of the health data collected.
DA FORM 5195 Fillable – Army Pubs 5195 PDF DOWNLOAD
