DAFORMFILLABLE.COM | DA FORM 3888 Fillable – Army Pubs 3888 PDF – The DA FORM 3888, titled Medical Record – Nursing History And Assessment, is a crucial document used by healthcare professionals within the United States Army. This form plays a vital role in recording a comprehensive nursing history and conducting thorough patient assessments. In this article, we’ll delve into the specifics of DA FORM 3888, its importance in medical documentation, and how it supports the delivery of high-quality patient care.
DA FORM 3888 – Medical Record – Nursing History And Assessment
| Form Number | DA Form 3888 |
| Form Title | Medical Record – Nursing History And Assessment |
| Form Date | 02/01/2003 |
| Form Proponent | TSG |
What is DA FORM 3888?
DA FORM 3888 is designed to capture detailed nursing history and the results of physical assessments of patients within military medical facilities. Established by the United States Army, this form ensures that all relevant patient information is systematically recorded and easily accessible to healthcare providers. The form’s structure aids in creating a consistent and complete medical record that supports effective patient management and care.
Key Characteristics of DA FORM 3888
- Publication Number: DA FORM 3888
- Publication Date: February 1, 2003
- Title: Medical Record – Nursing History and Assessment
- Proponent: The Surgeon General (TSG)
- Status: Active
- Prescribing Directive: AR 40-66
- Security Classification: Unclassified
- Distribution Restriction Code: Approved for public release; distribution is unlimited
This form is only produced in electronic media, as indicated by the footnote stating “42-ITEM ONLY PRODUCED IN ELECTRONIC MEDIA.”
Importance of DA FORM 3888 in Patient Care
Comprehensive Patient History
DA FORM 3888 is essential for recording a comprehensive nursing history, which includes past medical history, family history, and social history. This information provides healthcare providers with a deeper understanding of the patient’s overall health status and potential risk factors. Accurate and detailed patient history is crucial for making informed decisions about patient care and treatment plans.
Detailed Nursing Assessment
The form facilitates a detailed nursing assessment, which covers various physical and psychological aspects of the patient’s health. This includes vital signs, neurological status, cardiovascular health, respiratory function, gastrointestinal health, and more. By systematically recording this information, nurses and other healthcare providers can detect potential health issues early and intervene appropriately.
How to Use DA FORM 3888 Effectively
Ensure Accuracy and Completeness
When filling out DA FORM 3888, it is important to ensure that all information is accurate and complete. Incomplete records can lead to misdiagnosis or delayed treatment. Healthcare providers should double-check the information entered into the form to avoid any errors.
Follow the Prescribing Directive
Healthcare providers should adhere to the guidelines outlined in AR 40-66, the prescribing directive for DA FORM 3888. These guidelines ensure that the form is used consistently across different facilities and that all required data is captured effectively.
Conclusion
DA FORM 3888 – Medical Record – Nursing History And Assessment is a key tool in the documentation and management of patient care within military medical facilities. By providing a structured format for recording comprehensive patient history and detailed nursing assessments, this form enhances the quality of care provided to service members. Healthcare providers must use this form diligently and accurately to ensure that all pertinent patient information is available to support effective clinical decisions.
Incorporating DA FORM 3888 into daily medical practice not only streamlines patient documentation but also improves the overall efficiency of medical operations in the military. Understanding and utilizing this form is essential for all military nurses and healthcare professionals involved in patient care and assessment.
DA FORM 3888 Fillable – Army Pubs 3888 PDF DOWNLOAD
