DA Form 7593 Department of the Defense Military Working Dog Veterinary Service Referral Information Form

DA Form 7593 - also known as the "Department Of The Defense Military Working Dog Veterinary Service Referral Information Form" - is a United States Military form issued by the Department of the Army.

The form - often mistakenly referred to as the DD form 7593 - was last revised on May 1, 2006. Download an up-to-date fillable PDF version of the DA 7593 down below or look it up on the Army Publishing Directorate website.

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Department of Defense Military Working Dog Veterinary Service Referral Information Form
For use of this form, see AR 40-905; the proponent agency is OTSG.
SECTION I - ADMINISTRATIVE DATA
Part A - Referring Veterinarian Data
1. NAME
2. DATE (YYYYMMDD)
3. ADDRESS
4. PHONE (commercial & DSN)
5. FAX
6. E-mail
Part B - Animal Identification and Related Data
7. NAME OF ANIMAL
8. TATTOO NUMBER
9. BREED
10. DATE OF BIRTH (YYYYMMDD)
11. SEX
12. CERTIFICATION
13. OWNING SERVICE
14. DUTY STATION
15. CURRENT DIET (type, amount and frequency)
Part C - Kennelmaster/Handler Contact Data
16. NAME
17. ADDRESS
19. FAX
18. PHONE (commercial & DSN)
20. E-mail
SECTION II - CLINICAL DATA
21. CHIEF COMPLAINT (cc)
22. DURATION OF PROBLEM/CONDITION
APD LC v1.00
DA FORM 7593, MAY 2006
PAGE 1 OF 3
Department of Defense Military Working Dog Veterinary Service Referral Information Form
For use of this form, see AR 40-905; the proponent agency is OTSG.
SECTION I - ADMINISTRATIVE DATA
Part A - Referring Veterinarian Data
1. NAME
2. DATE (YYYYMMDD)
3. ADDRESS
4. PHONE (commercial & DSN)
5. FAX
6. E-mail
Part B - Animal Identification and Related Data
7. NAME OF ANIMAL
8. TATTOO NUMBER
9. BREED
10. DATE OF BIRTH (YYYYMMDD)
11. SEX
12. CERTIFICATION
13. OWNING SERVICE
14. DUTY STATION
15. CURRENT DIET (type, amount and frequency)
Part C - Kennelmaster/Handler Contact Data
16. NAME
17. ADDRESS
19. FAX
18. PHONE (commercial & DSN)
20. E-mail
SECTION II - CLINICAL DATA
21. CHIEF COMPLAINT (cc)
22. DURATION OF PROBLEM/CONDITION
APD LC v1.00
DA FORM 7593, MAY 2006
PAGE 1 OF 3
23. REFERRING VETERINARIAN SIGNIFICANT FINDINGS/REASON FOR MEDICAL REFERRAL
24. REFERRING VETERINARIAN ASSESSMENT/PROVISIONAL DIAGNOSIS
25. CURRENT MEDICATIONS (dose, frequency, duration - include past therapies if pertinent to current problem)
26. ADDITIONAL INFORMATION INCLUDED WITH RECORD (if applicable)
RADIOGRAPHS
CIVILIAN VETERINARY RECORDS
RECENT LAB RESULTS
OTHER:
27. ADDITIONAL REMARKS (use continuation page, if needed)
28. DODMWDVS CONSULTING VETERINARIAN
DA FORM 7593, MAY 2006
APD LC v1.00
PAGE 2 of 3
27. ADDITIONAL REMARKS (continuation page)
DA FORM 7593, MAY 2006
APD LC v1.00
PAGE 3 of 3

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