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DA Form 7809 is a DA series document issued for use across the Department of the Army. Official title: SUMMARY OF CARE BY NON-MILITARY MEDICAL PROVIDER. Purpose: summary of care by non-military medical provider. The current edition carries the date 12/01/2023 and is listed with a publication status of ACTIVE. The form runs to 1 page(s) and contains approximately 130 entry fields.
The office of primary responsibility is TSG. Use is prescribed by PAM 40-502, which defines when the form is raised and where it goes afterward. The form is normally completed by the subject of the entries or by administrative personnel maintaining the record, then reviewed and signed as the governing authority directs. A more recent edition has been published. This edition is superseded; it remains available for reference and for files already executed against it.
Formats offered: PDF. All are the same published layout in different containers, and the choice between them is a matter of how the entries will be made rather than what appears on the page. The pdf serves as the authoritative rendering. A fillable pdf exposes editable fields on screen; a printable pdf is the blank form as a flat page for handwriting.
A pdf opens in any current browser or in a dedicated reader. Fillable behaviour is more reliable in a full reader than in a browser viewer, where some field types render but do not save.
Every format is available at no charge and without sign-up. Files are distributed exactly as published, with no changes to the page.
What the form asks for
- AGR
- APFT_Test_Now_No
- APFT_Test_Now_Yes
- Additional_Medical_History
- Anticipation_Date
- Attachment_Button
- Brief_Summary
- Component_AC
- Component_AGR
- Component_ARNG
- Component_IDT_M_Day
- Component_ING
- Continuation
- CurrentPage
- DOD_ID_Number
- Date2
- Describe_Injuries
- Diagnosis
- FAX_Number
- Follow_Up
- Form_Rectangle
- Functional_Limitations_Permanent
- Functional_Limitations_Temporary
- Funtional_Activities_No1
The blocks are worked through in the order they appear on the sheet. At the head sit the identifying entries: name, identification number, unit, date. Because the filed record is indexed on these, they precede everything substantive.
Interactive fields are filled by typing into them. Movement between fields is by tab, following the order established when the form was constructed, which usually tracks the page layout. Check boxes and radio groups are set by clicking, and exclusive groups permit one selection at a time. A one-line field has no wrap: text beyond its width prints truncated even when the screen shows it. Overlong content is placed in remarks or on a continuation, not forced into the field.
Signature comes at the end, applied in ink or by an accepted electronic method. Until it is applied the document is a draft. Additional signatures — reviewer, approver, witness — are taken in printed block order, each dated when signed rather than when the form was drafted. The commonest error is a mandatory field left blank; where nothing applies, the entry is marked accordingly instead of being skipped. Transposed identification digits, day and month reversed in dates, and carried-over data from a reused working copy account for most of the remainder.
Forms that collect personal information bear a Privacy Act statement covering authority, purpose, routine uses, and whether the disclosure is required or optional. Reading it precedes completion. Once filled, the document contains personal data and is subject to the handling and storage rules that attach to such records.
Disposition of the completed document follows the prescribing authority — delivery to the office it names, transmission through the unit administrative channel, or placement in the individual's record, according to circumstance. The preparer keeps a copy. Retention is governed by the applicable records schedule, not by office custom.
Companion forms are traced by series and number. Within the DA series, documents sharing a proponent or a governing directive are frequently required together, and a form cited on the face of another is generally submitted alongside it. Continuation sheets, covers, and transmittal forms are part of that set and are assembled in advance of submission.
An edition stands until the proponent issues a revision. The printed edition date identifies the version, and a copy held locally is checked against the edition now in force before reuse. Prior executions under a superseded edition are not reopened for that reason.
The documents on this page are reproductions of published Department of the Army forms, offered for download. This is an independent site with no connection to the Department of the Army and no authority to issue forms. Nothing stated is legal advice, and no assurance is given regarding acceptance by any office. Doubts about a specific entry, requirement, or eligibility are resolved by the proponent or by the servicing administrative office.
Questions and answers
- What is DA Form 7809?
- SUMMARY OF CARE BY NON-MILITARY MEDICAL PROVIDER
- Which edition is current?
- 12/01/2023
- Who is responsible for this form?
- TSG
- In which formats can it be downloaded?
- PDF, PDF
Publisher notes
- PRIVACY ACT STATEMENT