DA FORM 3904 Fillable – Army Pubs 3904 PDF

DAFORMFILLABLE.COM | DA FORM 3904 Fillable – Army Pubs 3904 PDF – The DA FORM 3904, also known as the Public Voucher for Medical Examination, is an essential document used within the United States Army. This form plays a pivotal role in the medical examination process, ensuring that individuals receive the proper evaluations and that the associated costs are meticulously documented. In this article, we will delve into the details, purpose, and usage of DA FORM 3904, providing valuable insights for medical professionals, military personnel, and administrative staff involved in this process.

DA FORM 3904 – Public Voucher For Medical Examination

Form Number DA Form 3904
Form Title Public Voucher For Medical Examination
Form Date 08/01/1972
Form Proponent TSG

What is DA FORM 3904?

DA FORM 3904, titled “Public Voucher for Medical Examination,” is a standardized form used by the U.S. Army to document the financial details related to medical examinations. Created on August 1, 1972, this form remains an active tool in the military’s arsenal to manage medical services efficiently.

Key Details of DA FORM 3904

  • Pub/Form Number: DA FORM 3904
  • Pub/Form Date: 08/01/1972
  • Pub/Form Title: Public Voucher for Medical Examination
  • Pub/Form Proponent: TSG (The Surgeon General)
  • Pub/Form Status: ACTIVE
  • Prescribed Forms/Prescribing Directive: AR 40-400
  • Security Classification: UNCLASSIFIED
  • Distribution Restriction Code: A (Approved for public release; distribution is unlimited)

These details highlight the form’s longstanding importance and its wide accessibility, ensuring that it can be used without restriction in various settings.

Purpose and Use of DA FORM 3904

The primary purpose of the DA FORM 3904 is to serve as a voucher that details and justifies the expenses incurred during medical examinations. This form is crucial in scenarios where:

  • Medical examinations are needed for military personnel or dependents.
  • Documentation is required for financial reimbursement related to medical services.
  • Accurate record-keeping is essential for budgeting and auditing within military health services.

How to Use DA FORM 3904

Using DA FORM 3904 involves several key steps:

  1. Documenting the Recipient: Clearly identify the individual who received the medical examination.
  2. Detailing Services Provided: List all services provided during the examination, including tests and evaluations.
  3. Itemizing Costs: Specify the costs associated with each service.
  4. Totaling Expenses: Calculate the total cost that needs to be reimbursed or covered.
  5. Authorization: Ensure that all necessary approvals and signatures are obtained to process the voucher.

Important Considerations

When dealing with DA FORM 3904, several important factors need to be kept in mind:


Ensuring that all information on the form is accurate is vital. Errors can lead to delays in processing and potential issues with financial reimbursement.


Although the form is unclassified and approved for public release, personal medical information should be handled with care to respect privacy and confidentiality.


Stay informed about any changes or updates to the form or its prescribing directives (AR 40-400) to ensure compliance with current guidelines.


DA FORM 3904, the Public Voucher for Medical Examination, is a critical tool in the U.S. Army’s medical administrative processes. By providing a clear and structured way to document medical examination costs, this form helps streamline financial operations and ensures that personnel receive the medical attention they need with the proper financial oversight. Whether you are a medical professional, military personnel, or part of the administrative team, understanding how to use and manage this form is essential for efficient operations.

By keeping these details in mind and following the prescribed procedures, you can effectively utilize DA FORM 3904 to support medical examinations and ensure that all processes are conducted smoothly and transparently.

DA FORM 3904 Fillable – Army Pubs 3904 PDF DOWNLOAD

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