DA Form 4029 Patient's Clearance Record

DA Form 4029 or the "Patient's Clearance Record" is a Department of the Army-issued form used by and within the United States Military.

The form - often incorrectly referred to as the DD form 4029 - was last revised on March 1, 1973. Download an up-to-date fillable DA Form 4029 down below in PDF-format or look it up on the Army Publishing Directorate website.

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PATIENT'S CLEARANCE RECORD
For use of this form, see AR 40-400; the proponent agency is OTSG
DATE OF DISCHARGE
TIME OF DISCHARGE
SIGNATURE OF WARD OFFICER
PATIENT'S IDENTIFICATION
ACTIVITY CLEARANCE
(The final activity with which the patient must clear will be the disposition office.)
INITIALS*
INITIALS*
Military
Non-military
1.
1.
Patient's Trust Fund
Patient's Trust Fund
2.
2.
Medical Services Account Officer
Medical Services Account Officer
3.
3.
Clothing and Baggage
Clothing and Baggage
4.
4.
Medical Holding Unit
Postal Service
5.
a.
Supply
Change of Address
6.
b.
Pay Section
Other (Specify)
7.
c.
Service Records
8.
d.
Insurance and Allotments
5.
9.
Postal Service
6.
10.
Change of Address
7.
11.
Other (Specify)
8.
12.
9.
13.
REMARKS
DATE
SIGNATURE OF PATIENT ADMINISTRATOR
* INITIALS OF PERSON AUTHORIZING CLEARANCE.
DA FORM 4029, MAR 1973
REPLACES DA FORM 6-258, 1 DEC 59, WHICH WILL BE USED
APD LC v1.02ES
PATIENT'S CLEARANCE RECORD
For use of this form, see AR 40-400; the proponent agency is OTSG
DATE OF DISCHARGE
TIME OF DISCHARGE
SIGNATURE OF WARD OFFICER
PATIENT'S IDENTIFICATION
ACTIVITY CLEARANCE
(The final activity with which the patient must clear will be the disposition office.)
INITIALS*
INITIALS*
Military
Non-military
1.
1.
Patient's Trust Fund
Patient's Trust Fund
2.
2.
Medical Services Account Officer
Medical Services Account Officer
3.
3.
Clothing and Baggage
Clothing and Baggage
4.
4.
Medical Holding Unit
Postal Service
5.
a.
Supply
Change of Address
6.
b.
Pay Section
Other (Specify)
7.
c.
Service Records
8.
d.
Insurance and Allotments
5.
9.
Postal Service
6.
10.
Change of Address
7.
11.
Other (Specify)
8.
12.
9.
13.
REMARKS
DATE
SIGNATURE OF PATIENT ADMINISTRATOR
* INITIALS OF PERSON AUTHORIZING CLEARANCE.
DA FORM 4029, MAR 1973
REPLACES DA FORM 6-258, 1 DEC 59, WHICH WILL BE USED
APD LC v1.02ES

Download DA Form 4029 Patient's Clearance Record

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