DA FORM 4677 Fillable – Army Pubs 4677 PDF

DAFORMFILLABLE.COM | DA FORM 4677 Fillable – Army Pubs 4677 PDFDA FORM 4677 is an essential document within the United States Army’s health care system. Officially titled Therapeutic Documentation Care Plan (Non-Medications), this form plays a critical role in ensuring comprehensive and effective patient care without the use of medications.

DA FORM 4677 – Therapeutic Documentation Care Plan (Non-Medications)

Form Number DA Form 4677
Form Title Therapeutic Documentation Care Plan (Non-Medications)
Form Date 10/01/1978
Form Proponent TSG

Overview of DA FORM 4677

Purpose and Importance

The DA FORM 4677 serves as a therapeutic care plan designed specifically for non-medication treatments. This document is used to record and track various therapeutic interventions that are administered to patients, providing a structured and systematic approach to patient care. The form helps healthcare providers develop and document treatment plans that do not involve pharmaceutical solutions, ensuring that all aspects of patient care are considered.

Publication and Status

DA FORM 4677 was first published on October 1, 1978, and it remains an active form. Its use is mandated by the TSG (The Surgeon General) and is prescribed under the directive AR 40-66. As an official military document, it is classified as UNCLASSIFIED and approved for public release, with unlimited distribution.

Components of DA FORM 4677

Structure and Content

The form is detailed and structured to capture comprehensive information about the patient’s non-medication treatment plan. Key components include:

  • Patient Information: Basic details about the patient, including name, identification number, and contact information.
  • Therapeutic Interventions: Detailed documentation of the various non-medication therapies being administered. This can include physical therapy, psychological counseling, dietary modifications, and other therapeutic activities.
  • Treatment Goals: Clearly defined objectives that the therapeutic interventions aim to achieve.
  • Progress Notes: Regular updates and observations on the patient’s response to the treatment.
  • Signatures and Approvals: Spaces for healthcare providers to sign off on the documented care plan, ensuring accountability and oversight.

Electronic Availability

One of the notable aspects of DA FORM 4677 is that it is produced solely in electronic media. This makes it accessible and easy to distribute across various platforms, enhancing its usability within the military health system.

Utilization in Patient Care

Developing a Care Plan

When developing a therapeutic care plan using DA FORM 4677, healthcare providers must consider the individual needs of the patient. The form guides the development of a personalized treatment plan that focuses on non-medication interventions. This approach is particularly beneficial for patients who may not respond well to medications or for whom medications are not an appropriate solution.

Monitoring and Evaluation

The form is also used to monitor and evaluate the effectiveness of the therapeutic interventions. By documenting the patient’s progress and any adjustments made to the treatment plan, healthcare providers can ensure that the care being provided is effective and responsive to the patient’s needs.

Compliance and Regulations

Prescribing Directive

The use of DA FORM 4677 is governed by AR 40-66, which outlines the standards and procedures for medical record documentation within the Army. Compliance with this directive ensures that patient care is documented consistently and accurately.

Security and Distribution

As an unclassified document, DA FORM 4677 is approved for public release and has no restrictions on its distribution. This facilitates easy access for authorized personnel and ensures that the necessary documentation is available when needed.


DA FORM 4677 – Therapeutic Documentation Care Plan (Non-Medications) is a vital tool in the provision of holistic patient care within the Army’s healthcare system. By focusing on non-medication interventions, it allows healthcare providers to develop and document comprehensive care plans tailored to the unique needs of each patient. Adhering to the prescribed directives and utilizing the form effectively can significantly enhance the quality of care provided to military personnel.

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