DA Form 4574-r "Radiopharmaceutical Record"

What Is DA Form 4574-r?

This is a military form that was released by the U.S. Department of the Army (DA) on November 1, 1976. The form, often mistakenly referred to as the DD Form 4574-r, is a military form used by and within the U.S. Army. As of today, no separate instructions for the form are provided by the DA.

Form Details:

  • A 1-page document available for download in PDF;
  • The latest version available from the Army Publishing Directorate;
  • Editable, free, and easy to use;

Download an up-to-date fillable DA Form 4574-r down below in PDF format or browse hundreds of other DA Forms stored in our online database.

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Download DA Form 4574-r "Radiopharmaceutical Record"

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RADIOPHARMACEUTICAL STOCK RECORD
For use of this form, see TB MED 525; the proponent agency is the Office of The Surgeon General
Place Package
RADIOPHARMACEUTICAL
Label in This
MANUFACTURER
DATE
Space
LOT NUMBER
EXPIRATION DATE
PATIENT DOSE
BALANCER
PRESCRIPTION
ADMINIS-
ASSAY
NUMBER
PATIENT NAME
PROCEDURE
DATE
TIME
EMAIN-
NUMBER
TERED BY
ACTIVITY
VOLUME
(mCi/ml)
ING (ml)
(initials)
(mCi)
(ml)
DA FORM 4574-R, 1 NOV 1976
APD LC v1.00
RADIOPHARMACEUTICAL STOCK RECORD
For use of this form, see TB MED 525; the proponent agency is the Office of The Surgeon General
Place Package
RADIOPHARMACEUTICAL
Label in This
MANUFACTURER
DATE
Space
LOT NUMBER
EXPIRATION DATE
PATIENT DOSE
BALANCER
PRESCRIPTION
ADMINIS-
ASSAY
NUMBER
PATIENT NAME
PROCEDURE
DATE
TIME
EMAIN-
NUMBER
TERED BY
ACTIVITY
VOLUME
(mCi/ml)
ING (ml)
(initials)
(mCi)
(ml)
DA FORM 4574-R, 1 NOV 1976
APD LC v1.00