DA FORM 4465 Fillable – Army Pubs 4465 PDF

DAFORMFILLABLE.COM | DA FORM 4465 Fillable – Army Pubs 4465 PDFDA FORM 4465 – Patient Intake/Screening Record (PIR) is a crucial document used by the United States Army to gather and record essential information about patients during the intake and screening process. This form ensures that all necessary data is collected to provide appropriate medical care and maintain accurate records.

DA FORM 4465 – Patient Intake/Screening Record (PIR)

Form Number DA Form 4465
Form Title Patient Intake/Screening Record (PIR)
Form Date 11/01/2001
Form Proponent G-1

What is DA FORM 4465?

DA FORM 4465, also known as the Patient Intake/Screening Record (PIR), is a standardized form designated by the G-1 and has been in use since November 1, 2001. It is prescribed by PAM 600-85 and is exclusively available in electronic media, making it easily accessible for medical personnel.

Key Details of DA FORM 4465

  • Pub/Form Number: DA FORM 4465
  • Pub/Form Date: 11/01/2001
  • Pub/Form Proponent: G-1
  • Pub/Form Status: ACTIVE
  • Prescribed Forms/Prescribing Directive: PAM 600-85
  • Security Classification: UNCLASSIFIED
  • Pub/Form IDN: 990001
  • Pub/Form PIN: 069234

Purpose of DA FORM 4465

The Patient Intake/Screening Record (PIR) serves several essential functions in the medical intake process:

Comprehensive Patient Information

DA FORM 4465 collects detailed patient information, including personal data, medical history, and current health status. This information is vital for:

  • Ensuring accurate medical records.
  • Facilitating effective communication between healthcare providers.
  • Providing a foundation for tailored medical treatment.

Compliance with Privacy Regulations

The form requires a Privacy Act Statement as per AR 340-21, ensuring that patient information is handled in compliance with privacy regulations. This statement informs patients about the confidentiality of their data and their rights regarding the information provided.

Streamlining Medical Processes

By using a standardized form, DA FORM 4465 helps to streamline the patient intake process. It ensures that all necessary information is captured consistently, reducing the risk of errors and omissions. This standardization is particularly important in military medical settings, where accuracy and efficiency are paramount.

Components of DA FORM 4465

The Patient Intake/Screening Record (PIR) is divided into several sections to capture comprehensive patient information:

Personal Information

This section includes basic details such as:

  • Full name
  • Date of birth
  • Gender
  • Contact information

Medical History

Here, patients provide information about their:

  • Previous medical conditions
  • Current medications
  • Allergies
  • Family medical history

Current Health Status

In this part of the form, healthcare providers document:

  • Present symptoms
  • Vital signs (e.g., blood pressure, heart rate)
  • Recent medical visits or hospitalizations

Additional Screening Questions

To ensure a thorough assessment, DA FORM 4465 includes various screening questions related to:

  • Mental health
  • Substance use
  • Lifestyle factors (e.g., smoking, alcohol consumption)

Importance of Accurate Completion

Completing DA FORM 4465 accurately is crucial for several reasons:

  • Ensures Appropriate Care: Accurate information helps healthcare providers deliver the right treatment and interventions.
  • Enhances Patient Safety: By providing a complete medical history, patients reduce the risk of adverse reactions and complications.
  • Supports Data Integrity: Consistent and accurate records are essential for maintaining data integrity within the medical system.

Accessibility and Distribution

The Patient Intake/Screening Record (PIR) is produced only in electronic media, ensuring it is readily accessible to authorized personnel. The form is approved for public release and can be distributed without restrictions, making it available for widespread use in military medical facilities.


DA FORM 4465 – Patient Intake/Screening Record (PIR) is a vital tool in the medical intake process within the U.S. Army. By standardizing the collection of patient information, it ensures comprehensive and accurate medical records, supports patient safety, and facilitates effective healthcare delivery. Proper completion and use of this form are essential for maintaining high standards of medical care and compliance with privacy regulations.

For more information about DA FORM 4465 and its use, consult the prescribing directive PAM 600-85 or contact your local medical administration office.

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