DA FORM 4221 Fillable – Army Pubs 4221 PDF

DAFORMFILLABLE.COM | DA FORM 4221 Fillable – Army Pubs 4221 PDFDA FORM 4221 – Diabetic Record is a crucial document utilized within the United States Army for the meticulous tracking and management of diabetic care among service members. Established on February 1, 2003, this form is actively maintained by the Surgeon General (TSG) and plays an essential role in ensuring the health and readiness of personnel diagnosed with diabetes.

DA FORM 4221 – Diabetic Record

Form Number DA Form 4221
Form Title Diabetic Record
Form Date 02/01/2003
Form Proponent TSG

Purpose and Importance

DA FORM 4221 serves as a comprehensive record for documenting the medical history, treatment plans, and ongoing monitoring of individuals with diabetes. This form is integral to maintaining the continuity of care and ensuring that all healthcare providers have access to accurate and up-to-date information about a patient’s diabetic condition.

Key Features

  • Publication Date: 02/01/2003
  • Proponent: The Surgeon General (TSG)
  • Status: Active
  • Prescribing Directive: AR 40-66
  • Privacy Act Statement: Required (AR 340-21)

Detailed Breakdown of DA FORM 4221

Sections and Components

The DA FORM 4221 is designed to capture detailed information on various aspects of diabetic management. It includes sections for:

  • Patient Identification: Personal details and medical history.
  • Blood Glucose Monitoring: Regular tracking of blood sugar levels.
  • Insulin Administration: Documentation of insulin dosage and administration times.
  • Diet and Exercise: Recording dietary habits and physical activity.
  • Medical Appointments and Follow-ups: Scheduling and outcomes of medical visits.

Compliance and Privacy

AR 40-66 Compliance

As prescribed by AR 40-66, the DA FORM 4221 must be completed accurately and consistently. This regulation outlines the standards for medical records administration and healthcare documentation within the Army, ensuring that all medical records, including the diabetic record, meet stringent quality and reliability standards.

Privacy Considerations

In compliance with AR 340-21, the DA FORM 4221 requires a Privacy Act Statement. This is crucial to protect the personal health information (PHI) of service members, ensuring that their medical data is handled with the utmost confidentiality and security.

Accessibility and Distribution

Electronic Media

The DA FORM 4221 is produced exclusively in electronic media, which enhances accessibility and ease of distribution. This digital format ensures that healthcare providers can efficiently share and update records while maintaining data integrity.

Distribution Code

The form is classified under Distribution Restriction Code A, indicating that it is approved for public release and distribution is unlimited. This ensures that all relevant medical personnel and service members can access and utilize the form without restrictions.


DA FORM 4221 – Diabetic Record is an essential tool in the management of diabetes within the Army. By maintaining accurate and comprehensive records, this form ensures that service members receive consistent and effective care. Adhering to privacy regulations and utilizing electronic media, the DA FORM 4221 exemplifies the Army’s commitment to high standards in medical documentation and patient care.

Understanding and utilizing the DA FORM 4221 is vital for healthcare providers working within the military system, ensuring that all aspects of diabetic care are meticulously documented and managed.

DA FORM 4221 Fillable – Army Pubs 4221 PDF DOWNLOAD

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