DA Form 3888 "Medical Record - Nursing History and Assessment"

What Is DA Form 3888?

This is a military form that was released by the U.S. Department of the Army (DA) on February 1, 2003. The form, often mistakenly referred to as the DD Form 3888, 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 2-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 3888 down below in PDF format or browse hundreds of other DA Forms stored in our online database.

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Download DA Form 3888 "Medical Record - Nursing History and Assessment"

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MEDICAL RECORD - NURSING HISTORY AND ASSESSMENT
For use of this form, see AR 40-66; the proponent agency is the OTSG.
2. Admission Diagnosis.
1. Date
and Time of Admission.
(YYYYMMDD)
YES
NO
Patient's own words when possible.
3. Tell me what you know about your
illness/injury/hospitalization.
4. Do you have any other health problems?
5. Have you been hospitalized before? If so,
when and for what?
6. What medications have you been taking?
(to include prescription and over-the-counter
drugs) For how long?
7. Are you allergic to anything? If so, what?
What reaction?
8. Do you have any special needs that require
assistance with daily activities? (e.g. diet, eating,
bathing, elimination, ambulating, sleeping.)
Prosthetics: dentures, reading glasses, contacts.
9. What other concerns do you have?
10. How can we be most helpful?
11. Name of Local Contact/NOK.
12. Relationship.
13. Telephone Number.
14. Interviewer's Signature, Rank & Title.
15. Informant/Relationship.
16. Patient Identification.
17. Personal Articles and Valuables.
(Indicate disposition
of each item by initials.)
Item:
Bedside
Home
Treasurer
Other (specify)
DA FORM 3888, FEB 2003
APD LC v1.01ES
EDITION OF JUN 91 IS OBSOLETE.
Page 1 of 2
MEDICAL RECORD - NURSING HISTORY AND ASSESSMENT
For use of this form, see AR 40-66; the proponent agency is the OTSG.
2. Admission Diagnosis.
1. Date
and Time of Admission.
(YYYYMMDD)
YES
NO
Patient's own words when possible.
3. Tell me what you know about your
illness/injury/hospitalization.
4. Do you have any other health problems?
5. Have you been hospitalized before? If so,
when and for what?
6. What medications have you been taking?
(to include prescription and over-the-counter
drugs) For how long?
7. Are you allergic to anything? If so, what?
What reaction?
8. Do you have any special needs that require
assistance with daily activities? (e.g. diet, eating,
bathing, elimination, ambulating, sleeping.)
Prosthetics: dentures, reading glasses, contacts.
9. What other concerns do you have?
10. How can we be most helpful?
11. Name of Local Contact/NOK.
12. Relationship.
13. Telephone Number.
14. Interviewer's Signature, Rank & Title.
15. Informant/Relationship.
16. Patient Identification.
17. Personal Articles and Valuables.
(Indicate disposition
of each item by initials.)
Item:
Bedside
Home
Treasurer
Other (specify)
DA FORM 3888, FEB 2003
APD LC v1.01ES
EDITION OF JUN 91 IS OBSOLETE.
Page 1 of 2
MEDICAL RECORD - NURSING HISTORY AND ASSESSMENT
18. Additional Assessment Data.
Admission:
TPR
BP
WT
HT
19. Typed or Printed Name of RN.
20. Signature of RN and Date/Time
ASSESSMENT CATEGORIES:
d) Pain: Location, radiation, duration,
b) Female: Vaginal Discharge, LMP,
1.
Growth and Development
e) Intrathoracic tubes and/or dressing
last PAP smear (if applicable) etc.
2.
Neurological
5.
Pulmonary
c) Male: Abnormal discharge,
a) Orientation
a) Respirations: Rate, regularity, effec-
swelling, pain
b) Level of Consciousness: alert,
tiveness, depth, use of accessory muscles,
8.
Integumentary
drowsy, lethargic, comatose; responses:
nocturnal/external dyspnea. Chest
a) Lesions, pressure points,
to verbal and painful stimuli; ability to
movement associated with respirations
contractures
follow commands; reflexes.
b) Breath sounds: Clear to
b) Color, moisture, edema, turgor,
c) Describe abnormalities
auscultation, Rales, Rhonchi, Wheezes,
change in pigmentation
3.
Eyes, Ears, Nose, and Throat
etc.
9.
Musculoskeletal
a) Eyes: Pupils, vision
c) Oxygen: Percent given, liters/min,
a) Movement Purposeful/Non-
b) Ears: Hearing, drainage
method of administration continuous or
purposeful, ROM, muscle strength,
c) Rhinorrhea, nasal surgery/trauma
PRN
level of usual activity
d) Throat: Sore, difficulty swallowing,
d) Cough, sputum, suctioning
b) Foot care (as applicable), TED
appearance on inspection, lymph nodes
6.
Gastrointestinal
hose
e) Describe abnormalities
a) Abdominal: Auscuitation (bowel
10.
Psycho-Social
4.
Cardiovascular
sounds present), palpitation, abdominal
a) Adjustment to hospitalization
a) Skin: Color, temp, turgor, moisture
girth measurement (if applicable)
and illness, manner, mood, behavior,
b) Peripheral Circulation: Pulses,
b) Dressings and/or drains
relation to persons around them
edema, extremities
7.
Genitourinary
c) IV's: Contents of bottle hanging,
a) Urination: Continence, pattern
REFERENCE: DA Pam 40-5
bottle number, condition of site
change
AMEDD Stds of Nursing Practice
DA FORM 3888, FEB 2003
APD LC v1.01ES
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